Individual
WAEL TAHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4201 ST ANTOINE, SUITE 5A, DETROIT, MI 48201-2153
(313) 745-4525
(313) 993-0085
Mailing address
1560 E MAPLE RD, SUITE 400-CREDENTIALING, TROY, MI 48083-1138
(313) 745-4525
(313) 993-0085
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301091739
MI
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
4301091739
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000354853
BCBS PROVIDER NUMBER
—
01
—
39094
MEDICAL LICENSE
KY
05
—
64090418
—
KY
Enumeration date
06/02/2006
Last updated
04/25/2016
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