Provider Demographics
NPI:1265416432
Name:TCHIDA, MICHAEL CLIFFORD (PAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CLIFFORD
Last Name:TCHIDA
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7675 MADISON ST NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2753
Mailing Address - Country:US
Mailing Address - Phone:763-785-4500
Mailing Address - Fax:763-785-3314
Practice Address - Street 1:7675 MADISON ST NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2753
Practice Address - Country:US
Practice Address - Phone:763-785-4500
Practice Address - Fax:763-785-3314
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN8865363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant