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General NPI Number Information
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NPI Number | 1609837350
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Entity Type | Individual
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Provider Name | MICHAEL E TADLOCK CRNA
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 916 4TH AVE. SW
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City | PIPESTONE
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State | MN
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Zip | 56164
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Country | US
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Telephone | 507-825-5811
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Fax | 563-556-8334
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Provider Business Mailing Address
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Address Line | 916 4TH AVE. SW
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City | PIPESTONE
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State | MN
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Zip | 56164
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Country | US
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Telephone | 507-825-5811
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Fax | 563-556-8334
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | D103531
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 223779-0
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License Number State | MN
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