Basic Information
| Provider Information | |||||||||
| NPI: | 1326133208 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABBASI | ||||||||
| FirstName: | TARIQ | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29201 TELEGRAPH ROAD | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482130501 | ||||||||
| FaxNumber: | 2482130521 | ||||||||
| Practice Location | |||||||||
| Address1: | 29201 TELEGRAPH ROAD | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482130501 | ||||||||
| FaxNumber: | 2482130521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 4301044415 | MI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1045704 | 01 | CIGNA | OTHER | 5082099 | 01 | AETNA | OTHER |