Provider Demographics
NPI:1740363639
Name:TANDLER, JANICE DENA (MD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:DENA
Last Name:TANDLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:250 6TH ST E
Mailing Address - Street 2:APT 415
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-4911
Mailing Address - Country:US
Mailing Address - Phone:763-712-4000
Mailing Address - Fax:763-712-4013
Practice Address - Street 1:3301 7TH AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-4516
Practice Address - Country:US
Practice Address - Phone:763-712-4000
Practice Address - Fax:763-712-4013
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN38929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG34592Medicare UPIN