Individual
TANNER MAKSYMICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 UNIVERSITY CIR, MACOMB, IL 61455-1367
(765) 891-0503
Mailing address
700 LINDEN LN, MACOMB, IL 61455-1076
(765) 891-0503
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096004259
IL
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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