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General NPI Number Information
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NPI Number | 1013509553
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Entity Type | Individual
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Provider Name | EID TAHSINE EID FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 02/05/2021
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 14825 SOUTHFIELD RD
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City | ALLEN PARK
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State | MI
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Zip | 48101-2642
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Country | US
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Telephone | 313-383-7071
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Fax |
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Provider Business Mailing Address
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Address Line | 6838 HARTWELL ST
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City | DEARBORN
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State | MI
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Zip | 48126-1821
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Country | US
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Telephone | 313-377-5105
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704330225
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License Number State | MI
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