Provider Demographics
NPI:1225112196
Name:TANG, BENJAMIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:B
Last Name:TANG
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:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0451
Mailing Address - Country:US
Mailing Address - Phone:847-593-8460
Mailing Address - Fax:224-235-4652
Practice Address - Street 1:333 W 89TH AVE STE W2
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:317-671-7460
Practice Address - Fax:224-235-4652
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055168208G00000X
IN01033529A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI351859903012OtherBLUE SHIELD WI
330002905OtherRAILROAD MEDICARE PART B
IL911-08127OtherBLUE SHIELD IL
IN000000077842OtherANTHEM BCBS IN
IN100203000AMedicaid
IL351859903OtherILLINOIS PULIC AID