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General NPI Number Information
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NPI Number | 1124032024
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Entity Type | Individual
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Provider Name | MOHAMMED TARIQ VAKANI M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 510 ASHMUN ST SUITE 5
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-1964
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Country | US
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Telephone | 906-632-6013
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Fax | 906-632-8618
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Provider Business Mailing Address
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Address Line | 4602 DEPT
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City | CAROL STREAM
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State | IL
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Zip | 60122-0021
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Country | US
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Telephone | 906-225-4821
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 087007
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License Number State | MI
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