Healthcare Provider Details

I. General information

NPI: 1811277957
Provider Name (Legal Business Name): FARAH TANVEER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2011
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15474 N HAGGERTY RD
PLYMOUTH MI
48170
US

IV. Provider business mailing address

901 MCCLINTOCK DR STE 202
BURR RIDGE IL
60527-0872
US

V. Phone/Fax

Practice location:
  • Phone: 734-335-6103
  • Fax: 734-404-5317
Mailing address:
  • Phone: 888-220-6432
  • Fax: 630-654-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4301108931
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: