Individual ProviderTariq KakishInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address32121 Woodward Ave, Suite 204, Royal Oak, MI 48073-6237(248) 399-5492PECOS EnrollmentBased on the most recent information from CMS, provider Tariq Kakish is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 9:21 AM.Profile DetailsProvider ID1780752543Provider TypeIndividualFull NameKakish, TariqTitleDr.CredentialMDGenderMaleSole ProprietorYesEnumeration Date12/1/2006Last Updated10/22/2015Contact InformationPractice LocationPractice Address32121 Woodward Ave, Suite 204, Royal Oak, MI 48073-6237Phone(248) 399-5492Fax(248) 399-5792Mailing LocationMailing Address32121 Woodward Ave, Suite 204, Royal Oak, MI 48073-6237Phone(248) 399-5492Fax(248) 399-5792Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense4301067872MichiganProvider IdentifiersIDDescriptionIssuerIDP00600535DescriptionOtherIssuerRAILROAD MEDICAREMichiganID1106334211DescriptionOtherIssuerBCBS BCNMichiganID4421922DescriptionMedicaidIssuerUnlistedMichiganIDP00430910DescriptionOtherIssuerMEDICARE RAILROADMichigan