Provider Demographics
NPI:1457539116
Name:TANZMAN, BARAK (DO)
Entity Type:Individual
Prefix:
First Name:BARAK
Middle Name:
Last Name:TANZMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27901 WOODWARD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-0919
Mailing Address - Country:US
Mailing Address - Phone:248-799-2880
Mailing Address - Fax:248-414-3959
Practice Address - Street 1:27901 WOODWARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0919
Practice Address - Country:US
Practice Address - Phone:248-799-2880
Practice Address - Fax:248-414-3959
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI50110177092086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery