Provider Demographics
NPI:1467716514
Name:PFEFFERKORN, TASSIA ZOMA (MD)
Entity Type:Individual
Prefix:
First Name:TASSIA
Middle Name:ZOMA
Last Name:PFEFFERKORN
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:46325 W 12 MILE RD STE 390
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2464
Mailing Address - Country:US
Mailing Address - Phone:248-719-7271
Mailing Address - Fax:248-719-7245
Practice Address - Street 1:46325 W 12 MILE RD STE 390
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2464
Practice Address - Country:US
Practice Address - Phone:248-719-7271
Practice Address - Fax:248-719-7245
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301100187207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301100187OtherLARA MICHIGAN