Provider Demographics
NPI:1326133208
Name:ABBASI, TARIQ (MD)
Entity Type:Individual
Prefix:
First Name:TARIQ
Middle Name:
Last Name:ABBASI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:29201 TELEGRAPH ROAD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034
Mailing Address - Country:US
Mailing Address - Phone:248-213-0501
Mailing Address - Fax:248-213-0521
Practice Address - Street 1:29201 TELEGRAPH ROAD
Practice Address - Street 2:SUITE 550
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-213-0501
Practice Address - Fax:248-213-0521
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010444152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1045704OtherCIGNA
5082099OtherAETNA
E82648Medicare UPIN
1045704OtherCIGNA