Provider Demographics
NPI:1477900116
Name:TAK, FARZANA
Entity Type:Individual
Prefix:
First Name:FARZANA
Middle Name:
Last Name:TAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FARZANA
Other - Middle Name:N/A
Other - Last Name:RAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12200 E 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3093
Mailing Address - Country:US
Mailing Address - Phone:586-258-0206
Mailing Address - Fax:
Practice Address - Street 1:12200 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3093
Practice Address - Country:US
Practice Address - Phone:586-258-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010735682084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry