Provider Demographics
NPI:1285692749
Name:TARAS, RICHARD J (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:TARAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 72293
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:734-462-3232
Mailing Address - Fax:248-449-7103
Practice Address - Street 1:24285 KARIM BLVD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2952
Practice Address - Country:US
Practice Address - Phone:248-536-0410
Practice Address - Fax:248-536-0420
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010057252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI505968OtherCARE CHOICES
MI114353555Medicaid
MIRA820037OtherM-CARE
MI300H218760OtherBCBS
E31594Medicare UPIN
MI114353555Medicaid