Individual
MR. JOSE G. TANDOC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2601 ELECTRIC AVE, PORT HURON, MI 48060-6587
(810) 985-1500
(810) 966-3104
Mailing address
56432 EDGEWOOD DR, SHELBY TOWNSHIP, MI 48316-5832
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704207032
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JT207032
BLUE CROSS
MI
Enumeration date
09/26/2006
Last updated
07/08/2007
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