| Tara Deroo Llc | |
|
4127 Embassy Dr Se Grand Rapids MI 49546-2418 | |
| (616) 264-3200 | |
| (616) 264-3201 |
| Full Name | Tara Deroo Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4127 Embassy Dr Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Tara Deroo (SOCIAL WORKER) |
| Authorized Official Contact | 6162643200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tara Deroo Llc 4127 Embassy Dr Se Grand Rapids MI 49546-2418 Ph: (616) 264-3200 | Tara Deroo Llc 4127 Embassy Dr Se Grand Rapids MI 49546-2418 Ph: (616) 264-3200 |
| NPI Number | 1306187802 |
|---|---|
| Provider Enumeration Date | 03/07/2013 |
| Last Update Date | 03/07/2013 |
| Medicare PECOS PAC ID | 7214182583 |
|---|---|
| Medicare Enrollment ID | O20130313000173 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306187802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | 6801081584 (Michigan) | Primary |
| Provider Name | Tara L Deroo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205134194 PECOS PAC ID: 3971781386 Enrollment ID: I20110706000266 |
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