Healthcare Provider Details

I. General information

NPI: 1801053418
Provider Name (Legal Business Name): TAMER MASSARANI M.D P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 W BIG BEAVER RD B-5
TROY MI
48084-3504
US

IV. Provider business mailing address

1579 W BIG BEAVER RD B-5
TROY MI
48084-3504
US

V. Phone/Fax

Practice location:
  • Phone: 248-614-0124
  • Fax: 248-614-0126
Mailing address:
  • Phone: 248-614-0124
  • Fax: 248-614-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. TAMER MASSARANI
Title or Position: PRESIDENT
Credential: M.D
Phone: 248-614-0124