Basic Information
| Provider Information | |||||||||
| NPI: | 1861591976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANHEHCO | ||||||||
| FirstName: | CONCHITA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | HENRY FORD HEALTH SYSTEM | ||||||||
| Address2: | 22505 ALLEN ROAD | ||||||||
| City: | WOODHAVEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346716217 | ||||||||
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| Practice Location | |||||||||
| Address1: | HENRY FORD HEALTH SYSTEM | ||||||||
| Address2: | 22505 ALLEN ROAD | ||||||||
| City: | WOODHAVEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346716217 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 208000000X | 4301031461 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 129059610 | 05 | MI | MEDICAID | CT031461 | 01 | COMMERCIAL-COMMERCIAL NUMBER | OTHER | 700H262280 | 01 | BLUE CROSS-BLUE CROSS | OTHER | CT031461 | 01 | CHAMPUS-CHAMPUS | OTHER |