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General NPI Number Information
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NPI Number | 1902280597
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Entity Type | Individual
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Provider Name | TAHA ZAIDI DO
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Gender | Male
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 505 N JACKSON ST
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City | JACKSON
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State | MI
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Zip | 49201-1266
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Country | US
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Telephone | 773-989-3808
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Fax |
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Provider Business Mailing Address
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Address Line | 4764 N VIRGINIA AVE APT. 212
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City | CHICAGO
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State | IL
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Zip | 60625-3740
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101024631
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License Number State | MI
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