Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 22170 | WV |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 22170 | WV |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 4301081712 | MI |
NPI | 1184732281 |
---|---|
Provider Name | Melissa Jugo Tinney |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48104-5758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 25/02/2020 |