=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679394589
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAVIS A. DANCIK MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2024
-----------------------------------------------------
Last Update Date | 07/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30701 WOODWARD AVE
-----------------------------------------------------
City | ROYAL OAK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48073-0987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-835-5163
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 190
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48012-0190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-835-5163
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSCIAN
-----------------------------------------------------
Name | DR. TAVIS ANDREW DANCIK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 248-808-1228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------