MEDICARE: TENDERCARE MICHIGAN, INC.

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	208100000X	Physical Medicine & Rehabilitation Physician	710030	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	00255	OTHER	MI	BLUE CROSS BLUE SHIELD
3	70-0-G1-1010-0	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1306014477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDERCARE MICHIGAN, INC.

Provider Business Mailing Address
First Line	:	555 N BRADLEY HWY
Second Line	:	SUITE C
City	:	ROGERS CITY
State	:	MI
Zip	:	49779-1539
Country	:	US
Telephone Number	:	989-734-7575
Fax Number	:	989-734-7648

Provider Business Practice Location Address
First Line	:	555 N BRADLEY HWY
Second Line	:	SUITE C
City	:	ROGERS CITY
State	:	MI
Zip	:	49779-1539
Country	:	US
Telephone Number	:	989-734-7575
Fax Number	:	989-734-7648

Authorized Official
Title or Position	:	EXEUTIVE DIRECTOR
Name	:	MS. JOYAL PAVEY
Credential	:
Telephone Number	:	989-734-7948

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	02/15/2011

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