Healthcare Provider Details

I. General information

NPI: 1487851994
Provider Name (Legal Business Name): ROMEO H. TABBILOS, M.D.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 W GRAND BLVD SUITE 428
DETROIT MI
48202-3096
US

IV. Provider business mailing address

3011 W GRAND BLVD SUITE 428
DETROIT MI
48202-3096
US

V. Phone/Fax

Practice location:
  • Phone: 313-872-2740
  • Fax: 313-872-1875
Mailing address:
  • Phone: 313-872-2740
  • Fax: 313-872-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301031236
License Number StateMI

VIII. Authorized Official

Name: DR. ROMEO H TABBILOS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 313-872-2740