Provider Demographics
NPI:1225041627
Name:FAN, TAI-HWANG MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:TAI-HWANG
Middle Name:MICHAEL
Last Name:FAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 TAYLOR RD
Mailing Address - Street 2:SUITE 3230
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3588
Mailing Address - Country:US
Mailing Address - Phone:334-260-9142
Mailing Address - Fax:
Practice Address - Street 1:440 TAYLOR RD
Practice Address - Street 2:SUITE 3230
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3588
Practice Address - Country:US
Practice Address - Phone:334-260-9142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20255207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease