Healthcare Provider Details

I. General information

NPI: 1336958792
Provider Name (Legal Business Name): GREAT HEALTH MEDICAL MI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 N CENTER RD
FLINT MI
48506-3149
US

IV. Provider business mailing address

407 WILLOUGHBY AVE
BROOKLYN NY
11205-4590
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-0288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AZLAN TARIQ
Title or Position: OWNER
Credential:
Phone: 212-734-6621