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DOUGLAS TACKET DO PLLC NPI 1023145703


NPI Information

NPI: 1023145703
Provider Name: DOUGLAS TACKET DO PLLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
24 N SAINT JOSEPH AVE
SUITE G
NILES, MI
ZIP 49120
Phone: (269) 684-5002
Get Directions

DOUGLAS TACKET DO PLLC is a family medicine in Niles, MI. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DOUGLAS TACKET DO PLLC NPI is 1023145703. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

24 N SAINT JOSEPH AVE
SUITE G
NILES, MI
ZIP 49120-263
Phone: (269) 684-5002

The provider's authorized official is Douglas Tacket .
The authorized official title is Owner and has the following contact phone number (269) 684-5002.

The enumeration date for this NPI number is 2/28/2007 and was last updated on 3/15/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine5101012140MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1E95811MEDICARE UPINMICHIGAN
24560327MEDICAIDMICHIGAN
30N79920MEDICARE PINMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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