Individual
LORI J TATAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2122 HEALTH DR SW, WYOMING, MI 49519-9698
(616) 252-5790
(616) 252-5793
Mailing address
5900 BYRON CENTER AVE SW, MEDICAL ADMINISTRATION, WYOMING, MI 49519-9606
(616) 252-3243
(616) 252-0260
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
EL31055
NH
363AM0700X
Medical Physician Assistant
Primary
5601004900
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160C976180
BCBSM
MI
05
—
1942376165
—
MI
Enumeration date
11/28/2006
Last updated
05/29/2024
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