| Douglas Tacket Do Pllc | |
|
24 N Saint Joseph Ave Suite G Niles MI 49120-2263 | |
| (269) 684-5002 | |
| Not Available |
| Full Name | Douglas Tacket Do Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 24 N Saint Joseph Ave, Niles, Michigan |
| Authorized Official Name and Position | Douglas Tacket (OWNER) |
| Authorized Official Contact | 2696845002 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Douglas Tacket Do Pllc 3061 Christy Way Saginaw MI 48603-2267 Ph: (989) 791-2455 | Douglas Tacket Do Pllc 24 N Saint Joseph Ave Suite G Niles MI 49120-2263 Ph: (269) 684-5002 |
| NPI Number | 1023145703 |
|---|---|
| Provider Enumeration Date | 02/28/2007 |
| Last Update Date | 03/15/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023145703 | NPI | - | NPPES |
| 4560327 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5101012140 (Michigan) | Primary |
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