Individual
KENNETH JAMES TACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10366 STONEY POINT DR, SOUTH LYON, MI 48178-8053
(810) 355-8281
Mailing address
10366 STONEY POINT DR, SOUTH LYON, MI 48178-8053
(810) 355-8281
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
4301043465
MI
Other
Enumeration date
09/06/2023
Last updated
09/06/2023
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