MEDICARE: MR. OMAR ZIAD TARABAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	T610661982929	MI

General Provider Information

NPI Number	:	1295272680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OMAR ZIAD TARABAH

Provider Business Mailing Address
First Line	:	26340 ANN ARBOR TRL
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-1104
Country	:	US
Telephone Number	:	313-588-6444
Fax Number	:

Provider Business Practice Location Address
First Line	:	26340 ANN ARBOR TRL
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-1104
Country	:	US
Telephone Number	:	313-588-6444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/24/2017

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