Basic Information
| Provider Information | |||||||||
| NPI: | 1750497863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TARAKJI | ||||||||
| FirstName: | MUHAMMAD | ||||||||
| MiddleName: | ANAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 840063 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752840063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057275155 | ||||||||
| FaxNumber: | 5057275189 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 DR MARTIN LUTHER KING JR AVE NE STE 102 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871023666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057273040 | ||||||||
| FaxNumber: | 5057279590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD2011-0601 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | MD2011-0601 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.