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1275795239
TAMMY LYNN PROVATAS
GRAND RAPIDS, MI
NPI
1275795239
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207P00000X Emergency Medicine
(Licence: MI 4301092916)
Enumeration Date
2008-06-30
Last Update Date
2008-06-30
Business Address
Dr. TAMMY LYNN PROVATAS M.D.
100 MICHIGAN ST NE # MC-49
GRAND RAPIDS, MI 49503-2560
Phone number: 616-391-8879
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Mailing Address
Dr. TAMMY LYNN PROVATAS M.D.
1699 SYCAMORE DR
MUSKEGON, MI 49445-3400
Phone number: 231-740-3750
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