Healthcare Provider Details

I. General information

NPI: 1518695303
Provider Name (Legal Business Name): TAC MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E LONG LAKE RD STE 120
TROY MI
48085-4998
US

IV. Provider business mailing address

1120 E LONG LAKE RD STE 120
TROY MI
48085-4998
US

V. Phone/Fax

Practice location:
  • Phone: 248-946-9400
  • Fax: 586-816-1904
Mailing address:
  • Phone: 248-946-9400
  • Fax: 586-816-1904

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: DR. TAREK A CHAHINE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 248-670-3617