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General NPI Number Information
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NPI Number | 1528083045
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Entity Type | Individual
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Provider Name | PHILIP W TATE MD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 08/06/2012
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Provider Practice Location Address
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Address Line | 8333 FELCH ST SUITE 200
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City | ZEELAND
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State | MI
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Zip | 49464-2608
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Country | US
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Telephone | 616-772-4846
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Fax | 616-748-2855
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Provider Business Mailing Address
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Address Line | 100 MICHIGAN ST NE MC 845
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2560
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 4301046008
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License Number State | MI
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