| Kenneth P Tarr, DO | |
|
4700 Schaefer Rd., Dearborn, MI 48126-3698 | |
| (313) 581-2600 | |
| (313) 581-0228 |
| Full Name | Kenneth P Tarr |
|---|---|
| Gender | Male |
| Speciality | Diagnostic Radiology |
| Experience | 42 Years |
| Location | 4700 Schaefer Rd., Dearborn, Michigan |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902834070 | NPI | - | NPPES |
| CA5318 | Other | MI | MEDICARE RR GROUP PIN |
| 1876132 | Medicaid | MI | |
| 300073227 | Other | MI | RRMC |
| 3156310454 | Other | MI | BCBS PIN # |
| 1876123 | Medicaid | MI | |
| 310D460020 | Other | MI | BCBS GROUP PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 5101008688 (Michigan) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Mclaren Lapeer Region | Lapeer, MI | Hospital |
| Mclaren Caro Region | Caro, MI | Hospital |
| Mclaren Oakland | Pontiac, MI | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Kellam And Associates Pc | 6204830649 | 14 |
| Entity Name | North Oakland North Macomb Imaging Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1407842586 PECOS PAC ID: 3476526963 Enrollment ID: O20040813000422 |
| Entity Name | Southfield Rehabilitation Company |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1790785095 PECOS PAC ID: 6709872617 Enrollment ID: O20060414000038 |
| Entity Name | Kellam & Associates Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1366472029 PECOS PAC ID: 6204830649 Enrollment ID: O20060828000091 |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth P Tarr, DO 200 Oceangate, Suite 100, Long Beach, CA 90802-4317 Ph: (562) 499-6191 | Kenneth P Tarr, DO 4700 Schaefer Rd., Dearborn, MI 48126-3698 Ph: (313) 581-2600 |
Frankju A Arevalo, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 840 Oakwood Blvd, Dearborn, MI 48124 Phone: 313-359-7650 Fax: 313-359-7660 | |
Dr. Rohan Lalith Deraniyagala, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 18101 Oakwood Blvd, Dearborn, MI 48124 Phone: 248-551-5490 | |
Jerry W Drake, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 840 Oakwood Blvd, Dearborn, MI 48124 Phone: 313-359-7650 Fax: 313-359-7660 | |
Hassan Hamadi, DO Radiology Medicare: Medicare Enrolled Practice Location: 18101 Oakwood Blvd, Dearborn, MI 48124 Phone: 313-593-7000 | |
Joon K Kim, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 840 Oakwood Blvd, Dearborn, MI 48124 Phone: 313-359-7650 Fax: 313-359-7660 | |
Sophia M Roumanis, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 840 Oakwood Blvd, Dearborn, MI 48124 Phone: 313-359-7650 Fax: 313-359-7660 | |
Michael F Zydeck, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 840 Oakwood Blvd, Dearborn, MI 48124 Phone: 313-359-7650 Fax: 313-359-7660 |