Individual
MRS. MICHELLE L. TAUTKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
475 KILVERT STREET, SUITE 310, WARWICK, RI 02886
(781) 472-8650
Mailing address
475 KILVERT STREET, SUITE 310, WARWICK, RI 02886
(781) 472-8650
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1856
MA
363A00000X
Physician Assistant
Primary
PA1856
MA
363AM0700X
Medical Physician Assistant
PA00464
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA00464
RHODE ISLAND LICENSE
RI
Enumeration date
07/13/2005
Last updated
02/21/2023
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