Healthcare Provider Details

I. General information

NPI: 1972490134
Provider Name (Legal Business Name): MICHAEL TADROS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL TADROS

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 UNIVERSITY AVE W
SAINT PAUL MN
55104-4805
US

IV. Provider business mailing address

770 UNIVERSITY AVE W
SAINT PAUL MN
55104-4805
US

V. Phone/Fax

Practice location:
  • Phone: 347-325-4288
  • Fax: 347-325-4288
Mailing address:
  • Phone: 347-325-4288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: