Healthcare Provider Details

I. General information

NPI: 1245253657
Provider Name (Legal Business Name): TIFFANY ALLYN LETTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 44TH ST SW
WYOMING MI
49519-6439
US

IV. Provider business mailing address

5900 BYRON CENTER AVE SW MEDICAL ADMINISTRATION
WYOMING MI
49519-9606
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-8300
  • Fax: 616-252-8461
Mailing address:
  • Phone: 616-252-3243
  • Fax: 616-252-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301096762
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: