Provider Demographics
NPI:1972490134
Name:TADROS, MICHAEL (RN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TADROS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:TADROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:770 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4805
Mailing Address - Country:US
Mailing Address - Phone:347-325-4288
Mailing Address - Fax:
Practice Address - Street 1:770 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4805
Practice Address - Country:US
Practice Address - Phone:347-325-4288
Practice Address - Fax:347-325-4288
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging