Basic Information
| Provider Information | |||||||||
| NPI: | 1821207671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAPIA POSTIGO | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | GUSTAVO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3577 W 13 MILE RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480736710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482884500 | ||||||||
| FaxNumber: | 2482880450 | ||||||||
| Practice Location | |||||||||
| Address1: | 3577 W 13 MILE RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480736710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482884500 | ||||||||
| FaxNumber: | 2482880450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301087620 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 4301087620 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 700H273300 | 01 | MI | BLUE SHIELD | OTHER | 1821207671 | 05 | MI | MEDICAID |