Healthcare Provider Details

I. General information

NPI: 1154941706
Provider Name (Legal Business Name): SAIRA TARIQ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 11TH ST
NEWPORT KY
41071-2203
US

IV. Provider business mailing address

215 E 11TH ST
NEWPORT KY
41071-2203
US

V. Phone/Fax

Practice location:
  • Phone: 859-655-6100
  • Fax: 859-655-6186
Mailing address:
  • Phone: 859-655-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC3552
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036.165718
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0027171
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01093815A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: