Healthcare Provider Details

I. General information

NPI: 1184732281
Provider Name (Legal Business Name): MELISSA JUGO TINNEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ABUAN JUGO

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 SOUTH INDUSTRIAL HWY SUITE 400
ANN ARBOR MI
48104-5758
US

IV. Provider business mailing address

3621 S STATE ST
ANN ARBOR MI
48108-1633
US

V. Phone/Fax

Practice location:
  • Phone: 734-973-2400
  • Fax:
Mailing address:
  • Phone: 734-647-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number22170
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number22170
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number22170
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301081712
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: