Provider Demographics
NPI:1114917721
Name:MASSARANI, TAMER N (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMER
Middle Name:N
Last Name:MASSARANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1579 W BIG BEAVER RD
Mailing Address - Street 2:STE B5
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3504
Mailing Address - Country:US
Mailing Address - Phone:248-614-0124
Mailing Address - Fax:248-614-0126
Practice Address - Street 1:1579 W BIG BEAVER RD
Practice Address - Street 2:STE B5
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3504
Practice Address - Country:US
Practice Address - Phone:248-614-0124
Practice Address - Fax:248-614-0126
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2012-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051060208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4212987Medicaid
G26896Medicare UPIN