Individual
EDWARD TANUDJAJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1500 E SHERMAN BLVD, MUSKEGON, MI 49444-1849
(231) 672-2000
Mailing address
18379 WOODLAND RIDGE DR APT 6, SPRING LAKE, MI 49456-8924
(925) 437-8559
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5151015204
MI
Other
Enumeration date
05/05/2021
Last updated
05/05/2021
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