Provider Demographics
NPI:1508042193
Name:TANGUAY, JASON J (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:J
Last Name:TANGUAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1748
Mailing Address - Country:US
Mailing Address - Phone:708-709-6396
Mailing Address - Fax:708-709-6112
Practice Address - Street 1:333 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1748
Practice Address - Country:US
Practice Address - Phone:708-709-6396
Practice Address - Fax:708-709-6112
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4673170001OtherDMERC GROUP
ILP00448603/CK6882OtherRAILROAD MEDICARE
ILK48490/203979Medicare PIN
ILP00448603/CK6882OtherRAILROAD MEDICARE