Individual
DR. MATTHEW TANIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
80 68TH ST SE, GRAND RAPIDS, MI 49548-6980
(616) 486-5111
Mailing address
100 MICHIGAN ST NE # MC-845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101020029
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851654487
—
MI
Enumeration date
06/19/2012
Last updated
10/10/2014
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