MEDICARE: MR. BRIAN JAMES TSACOUMANGOS PA-C

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	363A00000X	Physician Assistant	5315090741	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346739224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN JAMES TSACOUMANGOS PA-C

Provider Business Mailing Address
First Line	:	5689 FRANCESCA LN
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-5752
Country	:	US
Telephone Number	:	586-295-0734
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 HANNAH BLVD STE 114
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-5380
Country	:	US
Telephone Number	:	517-364-8080
Fax Number	:	517-364-8088

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

Provider Enumeration Date	:	05/06/2018
Last Update Date	:	04/01/2024

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