Provider Demographics
NPI:1598904690
Name:KANG, MOHAMMAD TARIQ YASIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD TARIQ
Middle Name:YASIN
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:313-745-1741
Mailing Address - Fax:313-745-8165
Practice Address - Street 1:DRH ROSA PARKS WELLNESS INSTITUTE FOR SR HEALTH
Practice Address - Street 2:4201 ST ANTOINE STE 5B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-1741
Practice Address - Fax:313-745-8165
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2022-10-20
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Provider Licenses
StateLicense IDTaxonomies
MI4301083859207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630646Medicare PIN