Provider Demographics
NPI:1962670562
Name:TERRENCE W. TATARCHUK, M.D., P.C.
Entity Type:Organization
Organization Name:TERRENCE W. TATARCHUK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-775-1306
Mailing Address - Street 1:8795 PINE RIDGE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-9777
Mailing Address - Country:US
Mailing Address - Phone:231-775-1306
Mailing Address - Fax:231-775-9701
Practice Address - Street 1:8795 PINE RIDGE DR
Practice Address - Street 2:SUITE B
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-9777
Practice Address - Country:US
Practice Address - Phone:231-775-1306
Practice Address - Fax:231-775-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2093804Medicaid
MIB44609Medicare UPIN
MI2093804Medicaid