Douglas Tacket Do Pllc

NPI 1023145703 - Family Medicine - 207Q00000X

NPI Details
NPI 1023145703
Enumeration Date 02/28/2007
Last Updated 03/15/2010
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name DOUGLAS DOUGLAS
Position OWNER
Phone (269) 684-5002
Fax
Practice Location
24 N SAINT JOSEPH AVE
SUITE G
NILES MI, 49120-2263, US
Phone (269) 684-5002
Fax
Business Location
3061 CHRISTY WAY
SAGINAW MI, 48603-2267, US
Phone (989) 791-2455
Fax (989) 791-1392
Toxanomy
Taxonomy Code 207Q00000X
License State Michigan
License Number 5101012140
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According to our database, Douglas Tacket Do Pllc NPI is 1023145703, taxonomy code is 207Q00000X and license number is 5101012140, license state is located at Michigan. Douglas Tacket Do Pllc physically located at 24 N Saint Joseph Ave, Niles MI, 49120-2263. NPI Number 1033115704 has the healthcare provider type.

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1023145703 NPI number is provided on an as is basis without warranty of any kind. 1023145703 is maintained by the National Plan & Provider Enumeration System. The contents of Douglas Tacket Do Pllc are for informational purposes only.