Provider Demographics
NPI:1588676555
Name:TAN, MERITA RC (MD)
Entity Type:Individual
Prefix:
First Name:MERITA
Middle Name:RC
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:150 E. HURON STREET
Mailing Address - Street 2:825
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-751-7515
Mailing Address - Fax:312-751-1208
Practice Address - Street 1:150 E. HURON STREET
Practice Address - Street 2:825
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-751-7515
Practice Address - Fax:312-751-1208
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology