Healthcare Provider Details

I. General information

NPI: 1164787768
Provider Name (Legal Business Name): EDWARD A. TASHJIAN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CROSS CREEK PKWY STE 140
AUBURN HILLS MI
48326-2775
US

IV. Provider business mailing address

3100 CROSS CREEK PKWY STE 140
AUBURN HILLS MI
48326-2775
US

V. Phone/Fax

Practice location:
  • Phone: 248-332-0296
  • Fax: 248-332-3466
Mailing address:
  • Phone: 248-332-0296
  • Fax: 248-332-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberET046315
License Number StateMI

VIII. Authorized Official

Name: DIANE L BARROW
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-332-0296