Provider Demographics
NPI:1922062538
Name:BRESLIN, TARA M (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:BRESLIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446 LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5320 ELLIOTT DR
Practice Address - Street 2:SUITE 203
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1032
Practice Address - Country:US
Practice Address - Phone:734-475-4177
Practice Address - Fax:734-712-1744
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2016-06-02
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Provider Licenses
StateLicense IDTaxonomies
WI42352208600000X
MI4301089319208600000X, 2086X0206X
IL036.1318602086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33341100Medicaid
WI33341100Medicaid