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Organization
TRACY J TACKET DO PLLC
Active
Organization
TRACY J TACKET DO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY J TACKET DO (OWNER)
(269) 684-5002
Entity
Organization
Contact information
Practice address
24 N SAINT JOSEPH AVE, SUITE G, NILES, MI 49120-2263
(269) 684-5002
Mailing address
3061 CHRISTY WAY, SAGINAW, MI 48603-2267
(989) 791-2455
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101017117
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4994944
—
MI
Enumeration date
04/03/2007
Last updated
03/15/2010
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