Provider Demographics
NPI:1730105651
Name:TAN, IGNATIUS ING HAN (MD)
Entity Type:Individual
Prefix:
First Name:IGNATIUS
Middle Name:ING HAN
Last Name:TAN
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 1:4033 TAMPA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3224
Mailing Address - Country:US
Mailing Address - Phone:813-854-2003
Mailing Address - Fax:813-855-2367
Practice Address - Street 1:1850 CROSSINGS BLVD UNIT 100
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-6106
Practice Address - Country:US
Practice Address - Phone:813-475-7100
Practice Address - Fax:813-475-7119
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME-65867208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252902500Medicaid