Provider Demographics
NPI:1184690448
Name:DURANT, TAMMY M (MD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:M
Last Name:DURANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:2714 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-6715
Practice Address - Country:US
Practice Address - Phone:920-430-4760
Practice Address - Fax:920-430-4774
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080132207Q00000X
WI51732-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI004207305Medicare Oscar/Certification
P00697643Medicare Oscar/Certification
MII30565Medicare UPIN
MIOP383400037Medicare Oscar/Certification
WI075100084Medicare Oscar/Certification
WIK400279125Medicare Oscar/Certification