Basic Information
| Provider Information | |||||||||
| NPI: | 1205863669 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANIGUCHI | ||||||||
| FirstName: | MARSHALL | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 UNIVERSITY AVE E | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551012507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512293819 | ||||||||
| FaxNumber: | 6512657443 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 UNIVERSITY AVE E | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551012507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512293819 | ||||||||
| FaxNumber: | 6512657443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 03/31/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 36431 | MN | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 030763700 | 05 | MN | MEDICAID |