Provider Demographics
NPI:1699940122
Name:TATAR, AHSEN (MD)
Entity type:Individual
Prefix:
First Name:AHSEN
Middle Name:
Last Name:TATAR
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 1:315 E WARWICK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1083
Mailing Address - Country:US
Mailing Address - Phone:989-466-5486
Mailing Address - Fax:989-466-2486
Practice Address - Street 1:315 E WARWICK DR
Practice Address - Street 2:SUITE D
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1083
Practice Address - Country:US
Practice Address - Phone:989-466-5486
Practice Address - Fax:989-466-5023
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003180207V00000X
MI4301095343207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7000697591OtherPRIORITY HEALTH
MI1057125OtherMCLAREN HEALTH PLAN
MI1602900752OtherBCBSM
MI01025242OtherHEALTHPLUS COMMERCIAL
MI200000023314OtherPHYSICIANS HEALTH PLAN
MIM17670025Medicare PIN