Provider Demographics
NPI:1124032024
Name:VAKANI, MOHAMMED TARIQ (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:TARIQ
Last Name:VAKANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 DEPT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-0021
Mailing Address - Country:US
Mailing Address - Phone:906-225-4821
Mailing Address - Fax:
Practice Address - Street 1:510 ASHMUN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1964
Practice Address - Country:US
Practice Address - Phone:906-632-6013
Practice Address - Fax:906-632-8618
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI087007207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4856302Medicaid
MIP00359507OtherRAILROAD MEDICARE
MIMV087007OtherBCBSM
MIMV087007OtherBCBSM
MII57973Medicare UPIN