Provider Demographics
NPI:1518981307
Name:TAM, MICHELLE S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:S
Last Name:TAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SIN-MAN
Other - Middle Name:
Other - Last Name:TAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1870 LUNDY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1826
Mailing Address - Country:US
Mailing Address - Phone:408-573-9686
Mailing Address - Fax:408-922-0872
Practice Address - Street 1:1870 LUNDY AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1826
Practice Address - Country:US
Practice Address - Phone:408-573-9686
Practice Address - Fax:408-922-0872
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62269207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8516931Medicaid
CA8516931Medicaid
CA00A622690Medicare ID - Type Unspecified