Most Relevant Information
Provider Data
| NPI Number: | 1003499229 |
| Provider Name: | EDWARD TANUDJAJA DO |
| Entity Type: | Individual |
| Taxonomy Code: | 207R00000X |
| Specialty: | Internal Medicine |
| License Number: | 5151015204 |
Most Important Dates
| Enumeration Date: | 05/05/2021 |
| Last Updated: | 05/05/2021 |
Provider Practice Location
1500 E SHERMAN BLVD
MUSKEGON
MI
494441849
Practice Location Phone/Fax
| Phone: | 2316722000 |
| Fax: |
Provider Mailing Location
18379 WOODLAND RIDGE DR APT 6
SPRING LAKE
MI
494568924
Provider Mailing Phone/Fax
| Phone: | 9254378559 |
| Fax: |
Suggested EMR
Internist EMR