Healthcare Provider Details

I. General information

NPI: 1366892630
Provider Name (Legal Business Name): TAHEREH SOLEIMANI MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 RONALD REAGAN PKWY
AVON IN
46123-7085
US

IV. Provider business mailing address

1200 E MICHIGAN AVE STE 655
LANSING MI
48912-1837
US

V. Phone/Fax

Practice location:
  • Phone: 317-217-3000
  • Fax: 317-968-1067
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01090579A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: