Provider Demographics
NPI:1316905847
Name:NAKHLEH, TAWFIQ E (DO)
Entity type:Individual
Prefix:DR
First Name:TAWFIQ
Middle Name:E
Last Name:NAKHLEH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24327 FORD RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1129
Mailing Address - Country:US
Mailing Address - Phone:586-286-0639
Mailing Address - Fax:586-286-0657
Practice Address - Street 1:43171 DALCOMA DR
Practice Address - Street 2:SUITE 3
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6307
Practice Address - Country:US
Practice Address - Phone:586-286-0639
Practice Address - Fax:586-286-0657
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009511207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00992689OtherMEDICARE-RAILROAD
MI114075387Medicaid
MI0E03586OtherBCBSM
MI0E03586OtherBCBSM
MIF42239Medicare UPIN
MI050065433Medicare ID - Type UnspecifiedRAILROAD
MIN89910007Medicare PIN
MIMI5365001Medicare PIN