Provider Demographics
NPI:1326814880
Name:APOSTOLOVSKI, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:APOSTOLOVSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50475 GRATIOT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-3128
Mailing Address - Country:US
Mailing Address - Phone:248-609-1234
Mailing Address - Fax:
Practice Address - Street 1:50475 GRATIOT AVE STE B
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-3128
Practice Address - Country:US
Practice Address - Phone:248-609-1234
Practice Address - Fax:586-366-7153
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012531363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant