Individual provider Active NPI

Tamara Rae Lark, RD

  • Registered Dietitian
  • Livonia, MI
National Provider Identifier
1861382756
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Practice address
14555 Levan Rd Ste 311
Livonia, MI 48154-5085
Phone
(734) 655-2692
NPI assigned
Jul 3, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X Primary

Addresses

Primary practice location

14555 Levan Rd Ste 311
Livonia, MI 48154-5085

Mailing address

24 Frank Lloyd Wright Dr Ste J2000
Ann Arbor, MI 48105-9484
Phone (734) 747-6766

Other practice location 1

620 Byron Rd Ste 1200
Howell, MI 48843-1002
Phone (517) 545-6011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051013000609 MI Practitioner - Registered Dietitian Or Nutrition Professional 5193740686 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Olma Specialty 1 LLC CurrentSince Jul 1, 2025 Accepting new patients
Iha Olma Specialty 1 LLC CurrentSince Jul 1, 2025 Accepting new patients
Iha Health Services Corporation CurrentSince Jul 1, 2025 Accepting new patients
Iha Olma Specialty 1 LLC Current Accepting new patients
Iha Health Services Corporation Current Accepting new patients
Iha Health Service Corporation CurrentSince Jul 1, 2025 Accepting new patients
St Mary Mercy Hospital Past Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

620 Byron Rd
Ste 1200
Howell, MI 48843
Phone (517) 545-6011

14555 Levan Rd
Ste 311
Livonia, MI 48154
Phone (248) 858-3850

36475 5 Mile Rd
Livonia, MI 48154
Phone (734) 464-4800

19000 St Joes Pkwy
Livonia, MI 48152
Phone (734) 655-8250

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1861382756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR STE J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059484",
            "telephone_number": "734-747-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14555 LEVAN RD STE 311",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481545085",
            "telephone_number": "734-655-2692"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "620 Byron Rd Ste 1200",
            "address_purpose": "LOCATION",
            "city": "Howell",
            "state": "MI",
            "postal_code": "488431002",
            "country_code": "US",
            "telephone_number": "517-545-6011",
            "fax_number": "517-545-5122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARK",
        "first_name": "TAMARA",
        "middle_name": "RAE",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-03",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.