Basic Information
| Provider Information | |||||||||
| NPI: | 1245490739 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAHA | ||||||||
| FirstName: | TAREK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3531 S DONCASTER CT | ||||||||
| Address2: | APT D06 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486037900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433643230 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4701 TOWNE CENTRE RD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897906719 | ||||||||
| FaxNumber: | 9897909464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2008 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 01066701A | IN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 45863 | AZ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 11013957A | IN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 4301102463 | MI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1245490739 | 05 | MI | MEDICAID | 45863 | 01 | AZ | MEDICAL LICENSE NUMBER | OTHER | 699769 | 05 | AZ | MEDICAID | 4301102463 | 01 | MI | MEDICAL LICENSE NUMBER | OTHER | 01066701A | 01 | IN | MEDICAL LICENSE NUMBER | OTHER |