Basic Information
| Provider Information | |||||||||
| NPI: | 1487040739 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ST. CLAIR - BROWN | ||||||||
| FirstName: | TANEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ERIE CT STE 7140 | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603022510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735370020 | ||||||||
| FaxNumber: | 7735370029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 HAYES AVE | ||||||||
| Address2: | |||||||||
| City: | SANDUSKY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195022800 | ||||||||
| FaxNumber: | 4195022821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2015 | ||||||||
| LastUpdateDate: | 07/22/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34.012383 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 036146122 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.