Provider Demographics
NPI:1760473144
Name:TANASE, ALEXANDRU BOGDAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRU
Middle Name:BOGDAN
Last Name:TANASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1223 E SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-2940
Mailing Address - Country:US
Mailing Address - Phone:520-423-8282
Mailing Address - Fax:520-423-8398
Practice Address - Street 1:902 PROVIDENT DR STE A
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3379
Practice Address - Country:US
Practice Address - Phone:574-269-8338
Practice Address - Fax:574-269-8339
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28566208000000X
IN01080135A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics