Provider Demographics
NPI:1215917992
Name:TAHERI, AREZOO (MD)
Entity type:Individual
Prefix:MRS
First Name:AREZOO
Middle Name:
Last Name:TAHERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 25TH ST S
Mailing Address - Street 2:STE I
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103
Mailing Address - Country:US
Mailing Address - Phone:701-235-3050
Mailing Address - Fax:701-235-4525
Practice Address - Street 1:2301 25TH ST S
Practice Address - Street 2:STE I
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-235-3050
Practice Address - Fax:701-235-4525
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6556207RG0100X, 207RI0008X
ORMD192666207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13540Medicaid
ND13540Medicaid
ND711397Medicare ID - Type Unspecified