Healthcare Provider Details

I. General information

NPI: 1982676110
Provider Name (Legal Business Name): TAREK ELSHAARAWY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 CAPITAL AVE SW
BATTLE CREEK MI
49015-8332
US

IV. Provider business mailing address

3790 CAPITAL AVE SW
BATTLE CREEK MI
49015-8332
US

V. Phone/Fax

Practice location:
  • Phone: 269-979-6310
  • Fax: 269-979-8807
Mailing address:
  • Phone: 269-979-6310
  • Fax: 269-979-8807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2086S0122X
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number4301089405
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: