Provider Demographics
NPI:1326094095
Name:TAN, CARIDAD C (MD)
Entity Type:Individual
Prefix:
First Name:CARIDAD
Middle Name:C
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 PIERCE ST STE 402A
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3766
Mailing Address - Country:US
Mailing Address - Phone:712-252-8191
Mailing Address - Fax:712-252-8192
Practice Address - Street 1:2730 PIERCE ST STE 402A
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3766
Practice Address - Country:US
Practice Address - Phone:712-252-8191
Practice Address - Fax:712-252-8192
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28744207RN0300X
SD4626207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA120112Medicaid
IA120112Medicaid
IA0084822Medicaid
SDP00813563Medicare PIN
NE268021Medicare PIN
110080179OtherRAILROAD MEDICARE
F28642Medicare UPIN