Healthcare Provider Details

I. General information

NPI: 1164884102
Provider Name (Legal Business Name): ADAM S TABBAA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 COLUMBIA RD #200 STE #200
WESTLAKE OH
44145-7215
US

IV. Provider business mailing address

850 COLUMBIA RD STE 200
WESTLAKE OH
44145-7215
US

V. Phone/Fax

Practice location:
  • Phone: 440-808-0522
  • Fax: 440-808-2060
Mailing address:
  • Phone: 440-808-0522
  • Fax: 440-808-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.139711
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: