Provider Demographics
NPI:1093908568
Name:PACHA, TAREK (DO)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:
Last Name:PACHA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4316
Mailing Address - Country:US
Mailing Address - Phone:256-861-6480
Mailing Address - Fax:
Practice Address - Street 1:4137 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-4316
Practice Address - Country:US
Practice Address - Phone:256-861-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-19
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO1253208800000X
MI5101016847208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E06273OtherBCBSM
MICB9133OtherRAILROAD MEDICARE
MI0E06273OtherBCBSM