Provider Demographics
NPI:1972556413
Name:TAN, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:168 E MARKET ST
Mailing Address - Street 2:PO BOX 3542
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-2038
Mailing Address - Country:US
Mailing Address - Phone:330-375-3894
Mailing Address - Fax:330-375-6680
Practice Address - Street 1:75 ARCH ST
Practice Address - Street 2:STE. 506
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1429
Practice Address - Country:US
Practice Address - Phone:330-375-3894
Practice Address - Fax:330-375-6680
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-07-18
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Provider Licenses
StateLicense IDTaxonomies
OH35-079157207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2478313Medicaid
OH4135104OtherMEDICARE ID
I08269Medicare UPIN