Individual
DR. TAMMY LYNN PROVATAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 MICHIGAN ST NE # MC-49, GRAND RAPIDS, MI 49503-2560
(616) 391-8879
Mailing address
1699 SYCAMORE DR, MUSKEGON, MI 49445-3400
(231) 740-3750
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301092916
MI
Other
Enumeration date
06/30/2008
Last updated
06/30/2008
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