Healthcare Provider Details

I. General information

NPI: 1225004021
Provider Name (Legal Business Name): STEVEN MICHAEL TABACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S. BUENA VISTA ST. SUITE 440
BURBANK CA
91505
US

IV. Provider business mailing address

201 S. BUENA VISTA ST. SUITE 440
BURBANK CA
91505
US

V. Phone/Fax

Practice location:
  • Phone: 818-842-4819
  • Fax: 818-842-2086
Mailing address:
  • Phone: 818-842-4819
  • Fax: 818-842-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG062972
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG062972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: