Healthcare Provider Details

I. General information

NPI: 1043350622
Provider Name (Legal Business Name): KISHWAR ARA TAHIR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KISHWAR ARA AHMAD MD

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 E BIG BEAVER RD SUITE 201
TROY MI
48083-2053
US

IV. Provider business mailing address

1639 E BIG BEAVER RD STE 201
TROY MI
48083-2053
US

V. Phone/Fax

Practice location:
  • Phone: 248-528-9000
  • Fax:
Mailing address:
  • Phone: 248-528-9000
  • Fax: 248-528-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301048143
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301048143
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: