Individual
NANAKI TISACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3535 W 13 MILE RD STE 344, ROYAL OAK, MI 48073-6770
(248) 551-0497
Mailing address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
4351049150
MI
207RP1001X
Pulmonary Disease Physician
Primary
4351049150
MI
Other
Enumeration date
07/14/2020
Last updated
05/21/2025
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