Healthcare Provider Details

I. General information

NPI: 1639129646
Provider Name (Legal Business Name): TYANN R BILLMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 E CHICAGO RD
BRONSON MI
49028-1349
US

IV. Provider business mailing address

3785 BAY RD
SAGINAW MI
48603-2433
US

V. Phone/Fax

Practice location:
  • Phone: 517-858-1400
  • Fax: 517-858-1403
Mailing address:
  • Phone: 989-791-2455
  • Fax: 989-791-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003977
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: