Provider Demographics
NPI:1154363851
Name:LITTLE, TANIA (DO)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31500 TELEGRAPH ROAD
Mailing Address - Street 2:SUITE 010
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4315
Mailing Address - Country:US
Mailing Address - Phone:248-552-0620
Mailing Address - Fax:248-594-6745
Practice Address - Street 1:31500 TELEGRAPH RD STE 225
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4315
Practice Address - Country:US
Practice Address - Phone:248-552-0620
Practice Address - Fax:248-594-6745
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITL013930207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114527350Medicaid
MI0M75300013Medicare ID - Type Unspecified
MI114527350Medicaid