TARIQ KUTOB (NPI# 1497844120) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497844120 |
| Entity Type | Individual |
| Full Name | TARIQ KUTOB |
| Credential | D.O. |
| Practice Address |
3235 E Michigan Ave Jackson MI 49202-3971 |
| Practice Telephone | 5177873280 |
| Practice Fax Number | 5177871612 |
| Mailing Telephone | 5177873280 |
| Mailing Fax Number | 5177871612 |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 4301060391 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BOARD OF MEDICINE LICENSE | 4301060391 | 01 |
| Street Address |
3235 E MICHIGAN AVE |
| City | JACKSON |
| State | MI |
| Zip Code | 49202-3971 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578512851 | Craig Eugene Sponseller | Physician Assistant | 3235 E Michigan Ave, Jackson, MI 49202-3971 | 2006-05-06 |
| 1801163316 | Karen Van Eck | Nurse Practitioner | 3235 E Michigan Ave, Jackson, MI 49202-3971 | 2011-11-29 |
| 1437385382 | Shana A Ageloff-kupetz | Family Medicine | 3235 E Michigan Ave, Jackson, MI 49202-3971 | 2009-06-05 |
| 1770746943 | Joel David Miller | Family Medicine | 3235 E Michigan Ave, Jackson, MI 49202-3971 | 2008-07-08 |
| 1548489925 | Cascades Orthopedic Rehabilitation Services | Physical Therapist | 3235 E Michigan Ave, Jackson, MI 49202-3971 | 2007-04-24 |
| 1770613770 | Larry E Jennings Md PC | Family Medicine | 3235 E Michigan Ave, Jackson, MI 49202-3971 | 2007-03-07 |
| 1669554382 | Balasubramaniyam Pisupati | Rehabilitation Practitioner | 3235 E Michigan Ave, Jackson, MI 49202-3971 | 2006-10-20 |
| 1629179171 | Larry D Farr | Family Medicine | 3235 E Michigan Ave, Jackson, MI 49202-3971 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821590316 | Leslie Dominique Barroso | Social Worker | 834 Kennedy St, Jackson, MI 49202 | 2018-03-01 |
| 1073011136 | Nicole Szarek | Social Worker | 1200 N. West Ave, Jackson, MI 49202 | 2018-01-24 |
| 1598299430 | Cedric Griffin | Behavior Technician | 950 W. Monroe St, Jackson, MI 49202 | 2017-04-18 |
| 1285081612 | Patricia Decker | Psychologist | 950 West Monroe, Suite 500, Jackson, MI 49202 | 2016-05-16 |
| 1619344314 | Erica Ries | Social Worker | 1200 N West Ave Ste 800, Jackson, MI 49202 | 2015-08-28 |
| 1184007189 | Sarah Johnson | Behavioral Analyst | 818 Winifred St, Jackson, MI 49202 | 2015-07-08 |
| 1871971697 | Scott A Watterson Dds, Pllc | Dentist | 1030 Laurence Ave, Suite 3, Jackson, MI 49202 | 2015-05-13 |
| 1043608680 | Brenda Beverly | Counselor | 1190 West, 1190 West Suite 812, Jackson, MI 49202 | 2015-01-06 |
| 1295091593 | Natalie Ann Kember | Social Worker | 1206 Clinton, Jackson, MI 49202 | 2012-04-11 |
| 1912218728 | Tina Marie Pierce | Respite Care | 225 N Wisner St, Jakson, MI 49202 | 2010-06-25 |
| Find all providers in zip 49202 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235754995 | Oak Street Health Physicians Group of Mississippi, LLC | Family Medicine | 911 Ellis Ave, Jackson, MS 39209 | 2020-06-09 |
| 1003470758 | Central Mississippi Health Services, Inc | Family Medicine | 3450 Highway 80 W Ste 71, Jackson, MS 39209-7201 | 2019-04-29 |
| 1922515493 | Meaghan Schenk Johnson | Family Medicine | 2969 Curran Dr N # 200, Jackson, MS 39216-4121 | 2018-01-05 |
| 1740795731 | Emily Colleen Dunaway | Family Medicine | 1227 N State St # 101, Jackson, MS 39202-2002 | 2017-12-12 |
| 1679086367 | Hope Np House Call Practice | Family Medicine | 98 Grandview Ave, Jackson, OH 45640-9090 | 2017-11-16 |
| 1427585488 | Daniel Matthew Bender | Family Medicine | 455 W Broadway Ave, Jackson, WY 83001-8639 | 2017-05-21 |
| 1891235289 | Logan Hardin | Family Medicine | 1270 Union University Dr Ste A, Jackson, TN 38305-3856 | 2017-03-03 |
| 1255782843 | Seth Tyler Koehler | Family Medicine | 2600 E Main St, Jackson, MO 63755-2473 | 2016-06-25 |
| 1720495245 | Gopi Patel | Family Medicine | 27 S Cooks Bridge Rd Ste 2-1, Jackson, NJ 08527-2524 | 2014-07-16 |
| 1154735165 | Lk Physicians Services Pllc | Family Medicine | 36 Lake Pointe Dr, Jackson, TN 38305-8113 | 2014-06-17 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.