Healthcare Provider Details

I. General information

NPI: 1114660909
Provider Name (Legal Business Name): MR. TAREK ALKAHWAJI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKLANE BLVD STE E200
DEARBORN MI
48126-2400
US

IV. Provider business mailing address

801 NIGHTINGALE ST
DEARBORN MI
48128-1563
US

V. Phone/Fax

Practice location:
  • Phone: 313-846-2606
  • Fax: 313-846-2657
Mailing address:
  • Phone: 313-288-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: