Healthcare Provider Details

I. General information

NPI: 1790611754
Provider Name (Legal Business Name): TASNEEM ELGHREW M.D.
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SCHAEFER ROAD STE 240
DEARBORN MI
48126
US

IV. Provider business mailing address

4700 SCHAEFER ROAD SLE 240
DEARBORN MI
48126
US

V. Phone/Fax

Practice location:
  • Phone: 313-827-0480
  • Fax: 313-827-0472
Mailing address:
  • Phone: 313-827-0480
  • Fax: 313-827-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351056718
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: