Provider Demographics
NPI:1336194117
Name:DHABUWALA, TARLIKA CHIRPRIYA (MD)
Entity Type:Individual
Prefix:
First Name:TARLIKA
Middle Name:CHIRPRIYA
Last Name:DHABUWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5790 SOUTH MAIN STREET
Mailing Address - Street 2:STE J
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346
Mailing Address - Country:US
Mailing Address - Phone:248-625-8220
Mailing Address - Fax:248-625-6646
Practice Address - Street 1:5790 SOUTH MAIN STREET
Practice Address - Street 2:STE J
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-625-8220
Practice Address - Fax:248-625-6646
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301040084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1789529Medicaid
MI0806311281OtherBCBS
MI0806311281OtherBCBS
MI06311286Medicare ID - Type Unspecified