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General NPI Number Information
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NPI Number | 1518695303
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Entity Type | Organization
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Legal Business Name | TAC MEDICAL CENTER PC
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 1120 E LONG LAKE RD STE 120
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City | TROY
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State | MI
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Zip | 48085-4998
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Country | US
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Telephone | 248-946-9400
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Fax | 586-816-1904
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Provider Business Mailing Address
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Address Line | 1120 E LONG LAKE RD STE 120
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City | TROY
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State | MI
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Zip | 48085-4998
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Country | US
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Telephone | 248-946-9400
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Fax | 586-816-1904
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. TAREK A CHAHINE
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Credential | M.D.
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Telephone | 248-670-3617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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