MEDICARE: THOMAS N TAVARONE MD, FACS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	4301082748	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245214741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS N TAVARONE MD, FACS

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:	MC845
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:	616-486-6790
Fax Number	:	616-486-6702

Provider Business Practice Location Address
First Line	:	421 S BALDWIN ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-2102
Country	:	US
Telephone Number	:	616-225-8667
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/30/2013

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