Provider Demographics
NPI:1770873721
Name:TAHERI, MICHELLE N (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:N
Last Name:TAHERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 RIVER OAKS DR.
Mailing Address - Street 2:SUITE 320
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232
Mailing Address - Country:US
Mailing Address - Phone:601-936-1400
Mailing Address - Fax:601-936-0671
Practice Address - Street 1:1020 RIVER OAKS DR.
Practice Address - Street 2:SUITE 320
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:601-936-1400
Practice Address - Fax:601-936-0671
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MS23946207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6271218Medicaid