| Dr. Lucas Tanner, Llc | |
|
132 Depot St Gardner IL 60424-9401 | |
| (405) 795-3332 | |
| Not Available |
| Full Name | Dr. Lucas Tanner, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 132 Depot St, Gardner, Illinois |
| Authorized Official Name and Position | Lucas Aaron Tanner (OWNER) |
| Authorized Official Contact | 4057953332 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Lucas Tanner, Llc 21461 W Elmwood Ave Wilmington IL 60481-9613 Ph: (405) 795-3332 | Dr. Lucas Tanner, Llc 132 Depot St Gardner IL 60424-9401 Ph: (405) 795-3332 |
| NPI Number | 1194448480 |
|---|---|
| Provider Enumeration Date | 09/21/2022 |
| Last Update Date | 10/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194448480 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |