Individual
MR. ANDREW JOHN TAIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
N10565 GRANDVIEW LN, IRONWOOD, MI 49938-9622
(906) 932-1500
(906) 932-5630
Mailing address
N10565 GRANDVIEW LN, IRONWOOD, MI 49938-9622
(906) 932-1500
(906) 932-5630
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002513
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1034124
PREFERREDONE
—
01
—
12D87TA
BCBS
MN
05
—
42985500
—
WI
01
—
5601002513
PHYSICIAN ASSISTANT LICEN
MI
Enumeration date
05/24/2005
Last updated
07/08/2007
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