Provider Demographics
NPI:1225065089
Name:YOOK, TAE SIK (MD)
Entity Type:Individual
Prefix:
First Name:TAE
Middle Name:SIK
Last Name:YOOK
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:PO BOX 55 114
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48255
Mailing Address - Country:US
Mailing Address - Phone:248-858-3197
Mailing Address - Fax:248-858-3148
Practice Address - Street 1:15855 WEST 19 MILE RD
Practice Address - Street 2:ST JOSEPHS MEDICAL CENTER
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-263-2300
Practice Address - Fax:586-263-2595
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI033152207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4837156Medicaid
MI2206352931OtherBCBSM
MI4837156Medicaid