Tacket, Douglas Gregory

Tacket, Douglas Gregory is an individual health care provider with primary practice located at 4077 S Cleveland Ave , Saint Joseph MI 49085-9513. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Tacket, Douglas Gregory can be contacted via phone (269) 429-2992.

Contact Information

Primary practice address
4077 S Cleveland Ave Saint Joseph MI 49085-9513
Phone: (269) 429-2992
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 02001246A Indiana
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 5101012140 Michigan

Profile Details

NPI number 1790764868
LBN Legal business name Tacket, Douglas Gregory
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 17th, 2006
Last updated Feb 22nd, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790764868 NPPES
Michigan MEDICAID 114560327
Michigan Other 0851101104
Michigan Other 236040362
Michigan MEDICAID 300049695
Michigan Other 236040362

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