Individual
KENNETH P TARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4700 SCHAEFER RD., DEARBORN, MI 48126-3698
(313) 581-2600
(313) 581-0228
Mailing address
200 OCEANGATE, SUITE 100, LONG BEACH, CA 90802-4317
(562) 499-6191
(562) 499-6171
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5101008688
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1876123
—
MI
05
—
1876132
—
MI
01
—
300073227
RRMC
MI
01
—
310D460020
BCBS GROUP PIN
MI
01
—
3156310454
BCBS PIN #
MI
01
—
CA5318
MEDICARE RR GROUP PIN
MI
Enumeration date
06/29/2006
Last updated
01/24/2017
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us