MEDICARE: DR. ZIAD TAHAWI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	4301056426	MI
2	207RP1001X	Pulmonary Disease Physician	4301056426	MI

General Provider Information

NPI Number	:	1669425633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZIAD TAHAWI M.D.

Provider Business Mailing Address
First Line	:	23500 PARK ST STE 3
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2598
Country	:	US
Telephone Number	:	313-253-1000
Fax Number	:	313-253-1044

Provider Business Practice Location Address
First Line	:	23500 PARK ST STE 3
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2598
Country	:	US
Telephone Number	:	313-253-1000
Fax Number	:	313-253-1044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/21/2022

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