Tracy J Tacket DO PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101017117 Issued in MI

Legal business name

TRACY J TACKET DO PLLC

Practice address

24 N Saint Joseph Ave
Suite G
Niles, MI 49120-2263

Phone

(269) 684-5002

NPI assigned

Apr 3, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tracy J Tacket, DO

Title

Owner

Phone

(269) 684-5002

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268611200000",
    "number": "1992826366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3061 CHRISTY WAY",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486032267",
            "telephone_number": "989-791-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 N SAINT JOSEPH AVE",
            "address_2": "SUITE G",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202263",
            "telephone_number": "269-684-5002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACY J TACKET DO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2010-03-15",
        "status": "A",
        "authorized_official_last_name": "TACKET",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-684-5002",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101017117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4994944",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aubrey Therese Tompkins, CNM
• Jason C Tompkins, MD
• Raul Hector Torres III, D.O
• Stacey Marie Torzewski
• Lauren-Shylene Luna Toscano, NP
• Vivian Traub
• True Chiropractic, P.C.
• Shannon Keith Twiddy, M.D.
• Uma Parvati LLC
• Rosanne Van Dyke, MA

• Family Medicine Physician in Niles, MI
• Providers in Niles, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 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.

Verify at the official NPI Registry.