Provider Demographics
NPI:1356455398
Name:TAN, CAROL ANN C (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL ANN
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:PO BOX 2027
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-2027
Mailing Address - Country:US
Mailing Address - Phone:319-339-3855
Mailing Address - Fax:319-358-2791
Practice Address - Street 1:2769 HEARTLAND DR
Practice Address - Street 2:SUITE 205
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2732
Practice Address - Country:US
Practice Address - Phone:319-887-2900
Practice Address - Fax:319-339-3858
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095755207R00000X
IA40223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095755Medicaid
P00096917OtherRAILROAD MEDICARE
IL036095755Medicaid
P00096917OtherRAILROAD MEDICARE