Provider Demographics
NPI:1932171105
Name:TANI, PAUL M (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:TANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9801 DUPONT AVE S STE 425
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3873
Mailing Address - Country:US
Mailing Address - Phone:952-888-5800
Mailing Address - Fax:529-567-6176
Practice Address - Street 1:9801 DUPONT AVE S STE 425
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3873
Practice Address - Country:US
Practice Address - Phone:952-888-5800
Practice Address - Fax:529-567-6176
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN020832207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN974207700Medicaid
MND81619Medicare UPIN
MN180000186Medicare ID - Type Unspecified