Healthcare Provider Details

I. General information

NPI: 1467598524
Provider Name (Legal Business Name): MICHAEL TABA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 OHIO DR SUITE 200
PLANO TX
75093-5255
US

IV. Provider business mailing address

1705 OHIO DR SUITE 200
PLANO TX
75093-5255
US

V. Phone/Fax

Practice location:
  • Phone: 972-964-2626
  • Fax: 972-964-8180
Mailing address:
  • Phone: 972-758-3595
  • Fax: 972-599-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL M TABA
Title or Position: OWNER
Credential: MD
Phone: 972-964-2626