Provider Demographics
NPI:1225029739
Name:WASFIE, TARIK J (MD)
Entity Type:Individual
Prefix:MR
First Name:TARIK
Middle Name:J
Last Name:WASFIE
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 1:1127 VILLA LINDE CT
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3410
Mailing Address - Country:US
Mailing Address - Phone:810-720-2710
Mailing Address - Fax:810-720-5230
Practice Address - Street 1:1127 VILLA LINDE CT
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3410
Practice Address - Country:US
Practice Address - Phone:810-720-2710
Practice Address - Fax:810-720-5230
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITW056701208600000X
MI43010567012086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2753137Medicaid
MI020252550Medicare ID - Type Unspecified
E92705Medicare UPIN