MEDICARE: EUGENE TAY MD

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	207Q00000X	Family Medicine Physician	4301076395	MI
2	208M00000X	Hospitalist Physician	4301076395	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275589863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE TAY MD

Provider Business Mailing Address
First Line	:	245 STATE ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-4328
Country	:	US
Telephone Number	:	616-685-1808
Fax Number	:	616-685-1850

Provider Business Practice Location Address
First Line	:	300 LAFAYETTE AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-4692
Country	:	US
Telephone Number	:	616-685-6922
Fax Number	:	616-685-5101

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	04/27/2022

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Directions to “ EUGENE TAY MD” Practice Location

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