Provider Demographics
NPI:1598733693
Name:TANIR-AVCI, NARIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NARIN
Middle Name:
Last Name:TANIR-AVCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 S MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2990
Mailing Address - Country:US
Mailing Address - Phone:248-620-3700
Mailing Address - Fax:248-620-0228
Practice Address - Street 1:5905 S MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2990
Practice Address - Country:US
Practice Address - Phone:248-620-3700
Practice Address - Fax:248-620-0228
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301060849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3465520Medicaid
MIG25048Medicare UPIN
MI3465520Medicaid