MEDICARE: SARA TANDOC NP-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	363LA2200X	Adult Health Nurse Practitioner	4704240506	MI

General Provider Information

NPI Number	:	1871892760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA TANDOC NP-C

Provider Business Mailing Address
First Line	:	25600 SCHOENHERR RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-1447
Country	:	US
Telephone Number	:	586-777-6170
Fax Number	:	586-777-6582

Provider Business Practice Location Address
First Line	:	25600 SCHOENHERR RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-1447
Country	:	US
Telephone Number	:	586-777-6170
Fax Number	:

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

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	03/29/2019

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