Individual
DR. MICHAEL CHARLES TANKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3540-C NORTH 126TH STREET, BROOKFIELD, WI 53005-2403
(262) 790-9559
(262) 790-9609
Mailing address
25 NEEDHAM ST, NEWTON, MA 02461-1615
(617) 964-6681
(617) 630-0141
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1415
WI
Other
Enumeration date
07/10/2006
Last updated
07/08/2007
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