Provider Demographics
NPI:1629146493
Name:T N KAKISH MD PC
Entity Type:Organization
Organization Name:T N KAKISH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-399-5492
Mailing Address - Street 1:32121 WOODWARD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6237
Mailing Address - Country:US
Mailing Address - Phone:248-399-5492
Mailing Address - Fax:248-399-5792
Practice Address - Street 1:32121 WOODWARD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6237
Practice Address - Country:US
Practice Address - Phone:248-399-5492
Practice Address - Fax:248-399-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067872207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110F338390OtherBCN GROUP
MI1629146493Medicaid
MIDG3482OtherMEDICARE RAILROAD
MI110F338390OtherBC GROUP
MI110F338390OtherBC GROUP
MIDG3482OtherMEDICARE RAILROAD
MI0N50400Medicare PIN