Healthcare Provider Details

I. General information

NPI: 1497375166
Provider Name (Legal Business Name): TARA MAHER ELIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43494 WOODWARD AVE STE 106
BLOOMFIELD TOWNSHIP MI
48302-5053
US

IV. Provider business mailing address

43494 WOODWARD AVE STE 106
BLOOMFIELD TOWNSHIP MI
48302-5053
US

V. Phone/Fax

Practice location:
  • Phone: 248-590-0911
  • Fax:
Mailing address:
  • Phone: 248-590-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301509723
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: