Individual
MR. BILL J TACKE
Active
Individual
MR. BILL J TACKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4564
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0013286
—
MT
01
—
250002667
RR MEDICARE
MT
Enumeration date
12/14/2005
Last updated
09/16/2013
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