=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376040154
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AISHA TAI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2018
-----------------------------------------------------
Last Update Date | 11/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5901 CHASE RD STE 210
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126-0900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-869-4818
-----------------------------------------------------
Fax | 832-241-2902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47330 MARISA CT
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48170-3492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-985-8775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 4301512603
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------