Provider Demographics
NPI:1760615272
Name:HAGE, TALEB RADWAN (DO)
Entity type:Individual
Prefix:
First Name:TALEB
Middle Name:RADWAN
Last Name:HAGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1340 S COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3010
Mailing Address - Country:US
Mailing Address - Phone:248-438-6600
Mailing Address - Fax:248-313-9210
Practice Address - Street 1:1340 S COMMERCE RD
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3010
Practice Address - Country:US
Practice Address - Phone:248-438-6600
Practice Address - Fax:248-313-9210
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIL1593676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine