Provider Demographics
NPI:1508516865
Name:NAVARRO, NATHAN TAN (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:TAN
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 S COTTAGE GROVE AVE STE 4-200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615
Mailing Address - Country:US
Mailing Address - Phone:312-926-3627
Mailing Address - Fax:312-921-1051
Practice Address - Street 1:4822 S COTTAGE GROVE AVE STE 4-200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:312-921-1051
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.080694207Q00000X
IL036172742207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty