Provider Demographics
NPI:1679100887
Name:TACHAN, KONSTANTIN (DO)
Entity type:Individual
Prefix:
First Name:KONSTANTIN
Middle Name:
Last Name:TACHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8592 POTTER PARK DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5467
Mailing Address - Country:US
Mailing Address - Phone:941-921-6618
Mailing Address - Fax:941-922-0556
Practice Address - Street 1:8592 POTTER PARK DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5467
Practice Address - Country:US
Practice Address - Phone:941-921-6618
Practice Address - Fax:941-922-0556
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine