Provider Demographics
NPI:1043350622
Name:TAHIR, KISHWAR ARA (MD)
Entity type:Individual
Prefix:
First Name:KISHWAR
Middle Name:ARA
Last Name:TAHIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KISHWAR
Other - Middle Name:ARA
Other - Last Name:AHMAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1639 E BIG BEAVER RD
Mailing Address - Street 2:STE 201
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2053
Mailing Address - Country:US
Mailing Address - Phone:248-528-9000
Mailing Address - Fax:248-528-9005
Practice Address - Street 1:1639 E BIG BEAVER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2053
Practice Address - Country:US
Practice Address - Phone:248-528-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010481432084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F97800Medicare UPIN