Healthcare Provider Details

I. General information

NPI: 1619327368
Provider Name (Legal Business Name): STEPHANIE MEYER TARNACKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE MARIE MEYER

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14288 E OLD US HIGHWAY 12 STE 100
CHELSEA MI
48118-2700
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR # J2000
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 734-475-9175
  • Fax: 734-475-0120
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301117091
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: