Individual
ANDREA TIDY-CLARISA ALLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
701 S HEALTH PKWY, THREE RIVERS, MI 49093-8352
(269) 273-9789
(269) 273-9611
Mailing address
701 S HEALTH PKWY, MEDICAL STAFF OFFICE, THREE RIVERS, MI 49093-8352
(269) 273-9789
(269) 273-9611
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101018007
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033361084
BC BS MI
MI
05
—
1487658746
—
MI
01
—
700G560080
BCBS GROUP-THREE RIVERS HEALTH
MI
Enumeration date
10/21/2008
Last updated
09/22/2009
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