Individual
MR. MICHAEL E TADLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
916 4TH AVE. SW, PIPESTONE, MN 56164
(507) 825-5811
(563) 556-8334
Mailing address
916 4TH AVE. SW, PIPESTONE, MN 56164
(507) 825-5811
(563) 556-8334
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
223779-0
MN
367500000X
Certified Registered Nurse Anesthetist
D103531
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0453241
—
IA
05
—
44335300
—
WI
Enumeration date
03/31/2006
Last updated
12/12/2014
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