Healthcare Provider Details

I. General information

NPI: 1548624984
Provider Name (Legal Business Name): AYMAN TARABISHY MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34020 7 MILE RD STE 101
LIVONIA MI
48152-3093
US

IV. Provider business mailing address

PO BOX 30148
BELFAST ME
04915-2053
US

V. Phone/Fax

Practice location:
  • Phone: 248-900-1555
  • Fax: 502-977-8803
Mailing address:
  • Phone: 888-488-8289
  • Fax: 502-919-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4301099489
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: AYMAN TARABISHY
Title or Position: OWNER
Credential: MD
Phone: 201-982-3787