1508575382 NPI number — DR. MICHAEL TANZER MD

Table of content: DR. MICHAEL TANZER MD (NPI 1508575382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508575382 NPI number — DR. MICHAEL TANZER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANZER
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508575382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 APPLEWOOD ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPSTEAD
Provider Business Mailing Address State Name:
QUEBEC
Provider Business Mailing Address Postal Code:
H3X 3W6
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 CEDAR AVENUE
Provider Second Line Business Practice Location Address:
B5.159
Provider Business Practice Location Address City Name:
MONTREAL
Provider Business Practice Location Address State Name:
QUEBEC
Provider Business Practice Location Address Postal Code:
H3G 1A4
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
514-934-8240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XS0114X , with the licence number:  63246 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1850718 . This is a "RAMQ" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com