Individual
DR. COSTANDINOS TSAGARATOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(586) 263-2601
(586) 263-2589
Mailing address
38935 ANN ARBOR ROAD, PEC CREDENTIALING HFM, LIVONIA, MI 48150-3397
(248) 237-3226
(866) 250-6385
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101020835
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12655418
CAQH
MI
Enumeration date
07/05/2007
Last updated
10/26/2017
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