Provider Demographics
NPI:1841298825
Name:TEHRANI, REZA M (MD)
Entity type:Individual
Prefix:DR
First Name:REZA
Middle Name:M
Last Name:TEHRANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:363 FREMONT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3395
Mailing Address - Country:US
Mailing Address - Phone:269-969-6100
Mailing Address - Fax:269-969-6102
Practice Address - Street 1:363 FREMONT ST STE 100
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3395
Practice Address - Country:US
Practice Address - Phone:269-969-6100
Practice Address - Fax:269-969-6102
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRT062803207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2999360Medicaid
MI2999360Medicaid
MI2999360Medicaid