Individual
TAE WON PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1547 S WAYNE RD, WESTLAND, MI 48186
(734) 729-3133
(734) 729-3130
Mailing address
1547 S WAYNE RD, WESTLAND, MI 48186
(734) 729-3133
(734) 729-3130
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301035528
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109472710
—
MI
Enumeration date
02/14/2006
Last updated
09/28/2018
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