Individual
MICHAEL TANAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-1779
Mailing address
300 TWINING ST, MAXWELL AFB, AL 36112-6027
(334) 918-3328
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
37520
AL
208D00000X
General Practice Physician
37520
AL
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/30/2017
Last updated
07/24/2023
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