Individual
KEITH TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16656 PARKSIDE ST, DETROIT, MI 48221-3153
(313) 989-5536
Mailing address
16656 PARKSIDE ST, DETROIT, MI 48221-3153
(313) 974-9487
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
06/06/2022
Last updated
06/06/2022
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