Basic Information
| Provider Information | |||||||||
| NPI: | 1578526513 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANZER | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 269 CROSSING CRK N | ||||||||
| Address2: | |||||||||
| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432306110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143679444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5345 HENDRON RD | ||||||||
| Address2: | |||||||||
| City: | GROVEPORT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431251055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148350070 | ||||||||
| FaxNumber: | 6148350301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34002649 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0348010 | 05 | OH | MEDICAID |