| Doctor Name: | MICHAEL DEAN TANIS |
| NPI Number: | 1427155308 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | 4704123034 |
| Business Practice Address: | 211 W Pine Lake Dr Newaygo, MI - 493378029 |
| Business Phone Number: | 2316521631 |
| Business Fax Number: | 6162679047 |
| Mailing Address: | 100 Michigan St Ne # Mc845, GRAND RAPIDS |
| State: | MI |
| Postal Code: | 495032560 |
| Phone Number: | 6164866790 |
| Fax Number: | 6164866702 |
| NPI Enumeration Date: | 09/20/2006 |
| NPI Last Update Date: | 01/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704123034 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |