Provider Information for 1689922585
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Mrs. TRACY LEE EAGLE MS
Other Names:Former Name:Mrs. TRACY LEE GALLATIN BS, FAODPSex: Female
NPI: 1689922585
Last Updated: 2024-05-30
Certification Date: 2024-05-22
Certification Date: 2024-05-22
Details
| Name | Value | ||||||||||||
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| NPI | 1689922585 | ||||||||||||
| Enumeration Date | 2012-08-27 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 96 E GORDONVILLE RD MIDLAND, MI 48640-8384 United States Phone: 989-790-3366 | Fax:989-790-5027 | ||||||||||||
| Primary Practice Address | 4151 SHRESTHA DRIVE STE D SAGINAW, MI 48603-2190 United States Phone: 989-220-3060 | Fax:989-790-5027 | ||||||||||||
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