Provider Demographics
NPI:1962444679
Name:GARADA, TAREK (MD)
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:
Last Name:GARADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:23133 ORCHARD LAKE RD
Mailing Address - Street 2:SUIET 100
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3268
Mailing Address - Country:US
Mailing Address - Phone:248-477-0100
Mailing Address - Fax:248-477-6153
Practice Address - Street 1:23133 ORCHARD LAKE RD
Practice Address - Street 2:SUIET 100
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3268
Practice Address - Country:US
Practice Address - Phone:248-477-0100
Practice Address - Fax:248-477-6153
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301056867208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4117404Medicaid
MI125950OtherCARE CHOICES
MI063672OtherBLUE CROSS
MIP61346OtherBLUE CROSS
MI5770325OtherAETNA
MIC5269OtherMCARE
MIP61346OtherBLUE CROSS
F71988Medicare UPIN