Healthcare Provider Details

I. General information

NPI: 1568636629
Provider Name (Legal Business Name): TAREK SALIM HADLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29829 TELEGRAPH RD
SOUTHFIELD MI
48034-1330
US

IV. Provider business mailing address

18000 W 9 MILE RD
SOUTHFIELD MI
48075-4009
US

V. Phone/Fax

Practice location:
  • Phone: 248-336-4000
  • Fax: 248-581-8839
Mailing address:
  • Phone: 248-336-4000
  • Fax: 248-336-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301095806
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number4301095806
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125052101
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: