Healthcare Provider Details

I. General information

NPI: 1013975705
Provider Name (Legal Business Name): TARIK TIHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST FL 14
MIAMI FL
33136-2107
US

IV. Provider business mailing address

1120 NW 14TH ST FL 14
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-3172
  • Fax:
Mailing address:
  • Phone: 650-218-2385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License NumberME167616
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME167616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: