Individual
CHARLES R TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5500 ARMSTRONG RD, BATTLE CREEK, MI 49015-1014
(269) 966-5600
Mailing address
8038 N 24TH ST, KALAMAZOO, MI 49004-8621
(269) 966-5600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601001124
MI
Other
Enumeration date
08/23/2006
Last updated
07/08/2007
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