Provider Demographics
NPI:1679394589
Name:TAVIS A. DANCIK MD PLLC
Entity type:Organization
Organization Name:TAVIS A. DANCIK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TAVIS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DANCIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-808-1228
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-0190
Mailing Address - Country:US
Mailing Address - Phone:248-835-5163
Mailing Address - Fax:
Practice Address - Street 1:30701 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0987
Practice Address - Country:US
Practice Address - Phone:248-835-5163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty