Provider Demographics
NPI:1770779589
Name:TARIQUE, ZEESHAN (MD)
Entity type:Individual
Prefix:
First Name:ZEESHAN
Middle Name:
Last Name:TARIQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZEESHAN
Other - Middle Name:
Other - Last Name:BANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15555 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1896
Mailing Address - Country:US
Mailing Address - Phone:734-285-3090
Mailing Address - Fax:734-285-3095
Practice Address - Street 1:15555 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1896
Practice Address - Country:US
Practice Address - Phone:734-285-3090
Practice Address - Fax:734-285-3095
Is Sole Proprietor?:No
Enumeration Date:2007-09-15
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091464208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics