Provider Demographics
NPI:1851460018
Name:TANNER, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:TANNER
Suffix:
Gender:M
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:BELLEVUE HOSPITAL CENTER
Mailing Address - Street 2:FIRST AVENUE & 27TH STREET
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-562-1667
Mailing Address - Fax:212-562-1665
Practice Address - Street 1:316 W 79TH ST
Practice Address - Street 2:APT. 7E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6125
Practice Address - Country:US
Practice Address - Phone:212-562-1667
Practice Address - Fax:212-562-1665
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine