Healthcare Provider Details

I. General information

NPI: 1467410175
Provider Name (Legal Business Name): DANIEL DAVID TABAKA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 09/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8452
  • Fax: 330-543-3761
Mailing address:
  • Phone: 330-543-8452
  • Fax: 330-543-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number200500121
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number34.004369
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: