Provider Demographics
NPI:1598082117
Name:SHANKAR, TARA (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SHANKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:SUBBARAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4350 JACKSON RD STE 260
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1889
Mailing Address - Country:US
Mailing Address - Phone:734-434-3007
Mailing Address - Fax:734-434-6317
Practice Address - Street 1:2000 N HURON RIVER DR STE 200
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1791
Practice Address - Country:US
Practice Address - Phone:734-434-3007
Practice Address - Fax:734-434-6317
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301109466207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy