Provider Demographics
NPI:1982077400
Name:RAKOSKI, TARAH JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:JEAN
Last Name:RAKOSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TARAH
Other - Middle Name:JEAN
Other - Last Name:PITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:819 N SHIAWASSEE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1601
Mailing Address - Country:US
Mailing Address - Phone:989-541-2663
Mailing Address - Fax:989-723-3601
Practice Address - Street 1:819 N SHIAWASSEE ST STE 200
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1601
Practice Address - Country:US
Practice Address - Phone:989-541-2663
Practice Address - Fax:989-723-3601
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007716363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1982077400Medicaid