Provider Demographics
NPI:1790786960
Name:CHOWDHURY, TANJEEN (MD)
Entity Type:Individual
Prefix:
First Name:TANJEEN
Middle Name:
Last Name:CHOWDHURY
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:PO BOX 77000
Mailing Address - Street 2:DEPARTMENT 771036,
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2000
Mailing Address - Country:US
Mailing Address - Phone:586-447-4171
Mailing Address - Fax:586-447-4180
Practice Address - Street 1:25319 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3370
Practice Address - Country:US
Practice Address - Phone:586-447-4000
Practice Address - Fax:586-447-4009
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI442092Medicaid
MI442092Medicaid
MIH72646Medicare UPIN