Individual
DR. JUSTIN TANNIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5199 N ROYAL DR, TRAVERSE CITY, MI 49684-9201
(231) 935-8101
(231) 346-5926
Mailing address
1560 E. MAPLE RD., SUITE 400-CREDENTIALING, TROY, MI 48083
(313) 577-8900
(313) 577-0700
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301092763
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301092763
STATE LICENSE
MI
Enumeration date
01/30/2008
Last updated
05/28/2020
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