Basic Information
| Provider Information | |||||||||
| NPI: | 1598046526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIGAY | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | HARRIET | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1827 GOLF RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | BLOOMFIELD HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483021721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486266123 | ||||||||
| FaxNumber: | 2486266123 | ||||||||
| Practice Location | |||||||||
| Address1: | 21415 CIVIC CENTER DR | ||||||||
| Address2: | STE 355 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480763954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349414991 | ||||||||
| FaxNumber: | 7349414919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2011 | ||||||||
| LastUpdateDate: | 05/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704239481 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0H27351 | 01 | MI | BCBSM | OTHER | 1598046526 | 05 | MI | MEDICAID |