Healthcare Provider Details

I. General information

NPI: 1902280597
Provider Name (Legal Business Name): TAHA ZAIDI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N JACKSON ST
JACKSON MI
49201-1266
US

IV. Provider business mailing address

4764 N VIRGINIA AVE APT. 212
CHICAGO IL
60625-3740
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-3808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101024631
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: