MEDICARE: MELISSA JUGO TINNEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	22170	WV
2	208100000X	Physical Medicine & Rehabilitation Physician	22170	WV
3	2081P0004X	Spinal Cord Injury Medicine Physician	22170	WV
4	208100000X	Physical Medicine & Rehabilitation Physician	4301081712	MI

General Provider Information

NPI Number	:	1184732281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA JUGO TINNEY M.D.

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-1633
Country	:	US
Telephone Number	:	734-647-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 SOUTH INDUSTRIAL HWY
Second Line	:	SUITE 400
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-5758
Country	:	US
Telephone Number	:	734-973-2400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	02/25/2020

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