Provider Demographics
NPI:1700321973
Name:MASSENBERG, TAMIKO
Entity Type:Individual
Prefix:MS
First Name:TAMIKO
Middle Name:
Last Name:MASSENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAMIKO
Other - Middle Name:
Other - Last Name:MASSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38807 ANN ARBOR RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3896
Mailing Address - Country:US
Mailing Address - Phone:734-474-2958
Mailing Address - Fax:
Practice Address - Street 1:8623 N WAYNE RD STE 220
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1137
Practice Address - Country:US
Practice Address - Phone:734-474-2958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator