Provider Demographics
NPI:1750470696
Name:TAN, ANNIE (MD)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11850 BLACKFOOT ST NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2598
Mailing Address - Country:US
Mailing Address - Phone:763-721-2100
Mailing Address - Fax:763-721-2190
Practice Address - Street 1:11850 BLACKFOOT ST NW
Practice Address - Street 2:SUITE 100
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2598
Practice Address - Country:US
Practice Address - Phone:763-721-2100
Practice Address - Fax:763-721-2190
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN47116207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN07-05956OtherMEDICA
MN2368961OtherARAZ
MNHP53303OtherHEALTHPARTNERS
MN961141050294OtherPREFERREDONE
MN132945OtherUCARE
MN83694-0OtherFAIRVIEW
MN815T5TAOtherBCBS