Provider Demographics
NPI:1649239229
Name:TAO, ALVIN HENG (MD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:HENG
Last Name:TAO
Suffix:
Gender:M
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 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:2600 GREENBUSH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2479
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-446-7072
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032528A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN00000018276OtherANTHEM PROVIDER NUMBER
IN10826065OtherCAQH NUMBER
INTA12876018Medicaid
IN100078500Medicaid
IN9397539OtherPHCS PID NUMBER
IND95632Medicare UPIN
IN108832871Medicare PIN
IN100078500Medicaid