Provider Demographics
NPI:1245490739
Name:TAHA, TAREK (MD)
Entity type:Individual
Prefix:DR
First Name:TAREK
Middle Name:
Last Name:TAHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 S DONCASTER CT
Mailing Address - Street 2:APT D06
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-7900
Mailing Address - Country:US
Mailing Address - Phone:843-364-3230
Mailing Address - Fax:
Practice Address - Street 1:4701 TOWNE CENTRE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2834
Practice Address - Country:US
Practice Address - Phone:989-790-6719
Practice Address - Fax:989-790-9464
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066701A207X00000X
AZ45863207X00000X
IN11013957A207X00000X
MI4301102463207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1245490739Medicaid
AZ45863OtherMEDICAL LICENSE NUMBER
AZ699769Medicaid
MI4301102463OtherMEDICAL LICENSE NUMBER
IN01066701AOtherMEDICAL LICENSE NUMBER
MI1245490739Medicaid