Active NPI
Terrence Wayne Tatarchuk, MD
- Surgery Physician
- Cadillac, MI
National Provider Identifier
1073583316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 4301039879
- Practice address
- 8795 Pine Ridge Dr
Suite B
Cadillac, MI 49601-9777 - Phone
- (231) 775-1306
- Fax
- (231) 775-9701
- NPI assigned
- Jan 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 4301039879 | MI | Primary |
Addresses
Primary practice location
8795 Pine Ridge Dr
Suite B
Cadillac, MI 49601-9777
Mailing address
8795 Pine Ridge Dr
Suite B
Cadillac, MI 49601-9777
Phone (231) 775-1306
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01279 | Other | MI | PRIORITY HEALTH |
| 209380410 | Medicaid | MI | |
| 103633 | Other | MI | PREFERRED CHOICES |
| P26654F | Other | MI | BLUE CARE NETWORK |
| 0208309261 | Other | MI | BLUE CROSS BLUE SHIELD |
| M009095 | Other | MI | TRICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301039879 | MI | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266883200000",
"number": "1073583316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8795 PINE RIDGE DR",
"address_2": "SUITE B",
"city": "CADILLAC",
"state": "MI",
"postal_code": "496019777",
"telephone_number": "231-775-1306",
"fax_number": "231-775-9701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8795 PINE RIDGE DR",
"address_2": "SUITE B",
"city": "CADILLAC",
"state": "MI",
"postal_code": "496019777",
"telephone_number": "231-775-1306",
"fax_number": "231-775-9701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TATARCHUK",
"first_name": "TERRENCE",
"middle_name": "WAYNE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-26",
"last_updated": "2010-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MI",
"license": "4301039879",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIORITY HEALTH",
"identifier": "01279",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "209380410",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CHOICES",
"identifier": "103633",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "P26654F",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0208309261",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "M009095",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cadillac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.