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General NPI Number Information
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NPI Number | 1578501748
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Entity Type | Individual
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Provider Name | WAEL TAHA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 4201 ST ANTOINE SUITE 5A
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City | DETROIT
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State | MI
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Zip | 48201-2153
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Country | US
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Telephone | 313-745-4525
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Fax | 313-993-0085
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Provider Business Mailing Address
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Address Line | 1560 E MAPLE RD SUITE 400-CREDENTIALING
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City | TROY
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State | MI
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Zip | 48083-1138
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Country | US
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Telephone | 313-745-4525
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Fax | 313-993-0085
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301091739
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 4301091739
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License Number State | MI
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