Provider Demographics
NPI:1235404526
Name:TANNENBAUM, ERIC PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PHILIP
Last Name:TANNENBAUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:940 N MARR RD STE C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2610
Mailing Address - Country:US
Mailing Address - Phone:812-376-9353
Mailing Address - Fax:812-376-3757
Practice Address - Street 1:4665 N US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-8558
Practice Address - Country:US
Practice Address - Phone:812-376-9353
Practice Address - Fax:812-376-3757
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2023-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01079665A207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine