Provider Demographics
NPI:1467710582
Name:DR. BENOIT TANO, LTD
Entity Type:Organization
Organization Name:DR. BENOIT TANO, LTD
Other - Org Name:THE ALLERGY AND OBESITY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENOIT
Authorized Official - Middle Name:
Authorized Official - Last Name:TANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-372-8266
Mailing Address - Street 1:1451 44TH AVE S STE F
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3434
Mailing Address - Country:US
Mailing Address - Phone:855-372-8266
Mailing Address - Fax:701-732-2701
Practice Address - Street 1:1451 44TH AVE S STE F
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3434
Practice Address - Country:US
Practice Address - Phone:855-372-8266
Practice Address - Fax:701-732-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15417Medicaid
NDI72874Medicare UPIN