Provider Demographics
NPI:1326235789
Name:TANNAS, HENRI C (MD)
Entity Type:Individual
Prefix:
First Name:HENRI
Middle Name:C
Last Name:TANNAS
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 1:8210 WALNUT HILL LN STE 408
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4428
Mailing Address - Country:US
Mailing Address - Phone:214-647-1836
Mailing Address - Fax:
Practice Address - Street 1:8210 WALNUT HILL LN STE 408
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4428
Practice Address - Country:US
Practice Address - Phone:214-647-1836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233564207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2146665Medicaid
MA000357401Medicare PIN