Provider Demographics
NPI:1407815277
Name:TAN, TINA QUANBEE (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:QUANBEE
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 1:225 EAST CHICAGO AVE BOX #20
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2605
Mailing Address - Country:US
Mailing Address - Phone:312-227-4000
Mailing Address - Fax:312-227-9709
Practice Address - Street 1:225 EAST CHICAGO AVE BOX #20
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2605
Practice Address - Country:US
Practice Address - Phone:312-227-4000
Practice Address - Fax:312-227-9709
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360896802080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089680Medicaid
ILL34459Medicare ID - Type Unspecified