MEDICARE: DIANNE D TYNDALL LMSW

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	104100000X	Social Worker	6801064849	MI

General Provider Information

NPI Number	:	1437370491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE D TYNDALL LMSW

Provider Business Mailing Address
First Line	:	3495 S CENTER RD
Second Line	:
City	:	BURTON
State	:	MI
Zip	:	48519-1455
Country	:	US
Telephone Number	:	810-424-2007
Fax Number	:	810-743-1099

Provider Business Practice Location Address
First Line	:	4901 TOWNE CENTRE RD
Second Line	:	STE 300
City	:	SAGINAW
State	:	MI
Zip	:	48604-2841
Country	:	US
Telephone Number	:	989-498-5100
Fax Number	:	989-498-0197

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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