Healthcare Provider Details

I. General information

NPI: 1255868576
Provider Name (Legal Business Name): DAVID TOBIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 W ANN ARBOR TRL STE 210
PLYMOUTH MI
48170-6202
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR STE J2000
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 734-455-4600
  • Fax: 734-455-5637
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301501616
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: