Healthcare Provider Details

I. General information

NPI: 1720880990
Provider Name (Legal Business Name): TAHIRA HEALTH, WELLNESS AND WEIGHT LOSS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 COUNTY ROAD 101
MINNETONKA MN
55345-1016
US

IV. Provider business mailing address

16925 54TH AVE N
PLYMOUTH MN
55446-3882
US

V. Phone/Fax

Practice location:
  • Phone: 612-492-1727
  • Fax: 800-507-8621
Mailing address:
  • Phone: 612-590-4258
  • Fax: 800-507-8621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NADIA MALIK
Title or Position: MD
Credential:
Phone: 763-577-7400