Provider Demographics
NPI:1992751887
Name:TATTAN, DAVID CHARLES (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:TATTAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3165 24TH AVE
Mailing Address - Street 2:P.O. BOX 230
Mailing Address - City:JAMESTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:49427-0230
Mailing Address - Country:US
Mailing Address - Phone:616-896-8382
Mailing Address - Fax:616-896-7669
Practice Address - Street 1:3165 24TH AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:MI
Practice Address - Zip Code:49427-0230
Practice Address - Country:US
Practice Address - Phone:616-896-8382
Practice Address - Fax:616-896-7669
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2119606Medicaid
MIB42899Medicare UPIN
MI5700153Medicare ID - Type Unspecified