Individual
DR. ELLEN TAMBUNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4 LONGMEADOW VILLAGE DR, NILES, MI 49120-7809
(269) 684-6000
(269) 684-1388
Mailing address
6416 DEANS HILL RD, BERRIEN CENTER, MI 49102-9750
(269) 471-7741
(269) 471-1581
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301062919
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339031110
—
MI
Enumeration date
02/13/2006
Last updated
03/07/2023
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