Healthcare Provider Details

I. General information

NPI: 1982059242
Provider Name (Legal Business Name): CARL TABB II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 08/01/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S HOSPITAL OF MI 3901 BEAUBUEN
DETROIT MI
48201-2119
US

IV. Provider business mailing address

UNIVERSITY PEDIATRICIANS 4201 ST. ANTOINE UHC 5D - MAILBOX 226
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5638
  • Fax: 313-745-5867
Mailing address:
  • Phone: 313-966-5051
  • Fax: 313-966-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301119065
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35C.001714
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4301119065
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35C.001714
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0103067
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberD0103067
License Number StateMD
# 7
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA201490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: