Provider Demographics
NPI:1659342665
Name:TANLIM, ALBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:C
Last Name:TANLIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:819 W LAFAYETTE ST
Mailing Address - Street 2:#93
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970
Mailing Address - Country:US
Mailing Address - Phone:815-432-4743
Mailing Address - Fax:
Practice Address - Street 1:845 S 4TH ST
Practice Address - Street 2:ROBERTS CLINIC LTD
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1628
Practice Address - Country:US
Practice Address - Phone:815-432-2461
Practice Address - Fax:815-432-2535
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091262207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3711693620021Medicaid
IL03815080OtherBC BS
IN200386800AMedicaid
K10959OtherPIN
IL036091262Medicaid
IL210046 K10959Medicare ID - Type UnspecifiedWPS
G20853Medicare UPIN
IL3711693620021Medicaid
K10959OtherPIN