Individual
SHILOH TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5087 N ROYAL DR, TRAVERSE CITY, MI 49684-6987
(231) 935-0440
(231) 935-0445
Mailing address
550 MUNSON AVE, TRAVERSE CITY, MI 49686-3580
(231) 935-6600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301502100
MI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
4301502100
MI
207RP1001X
Pulmonary Disease Physician
Primary
4301502100
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2014
Last updated
04/07/2026
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