MEDICARE: DR. MICHAEL TADIN D.O.

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	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1578605119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL TADIN D.O.

Provider Business Mailing Address
First Line	:	2210 W WABANSIA AVE
Second Line	:	#404
City	:	CHICAGO
State	:	IL
Zip	:	60647-5477
Country	:	US
Telephone Number	:	773-973-6380
Fax Number	:	773-973-6390

Provider Business Practice Location Address
First Line	:	6230 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-1208
Country	:	US
Telephone Number	:	773-973-6380
Fax Number	:	773-973-6390

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/09/2007

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