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General NPI Number Information
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NPI Number | 1003988577
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Entity Type | Individual
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Provider Name | BRUCE TABAK D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 129 S WASHINGTON ST
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City | OXFORD
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State | MI
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Zip | 48371-4981
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Country | US
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Telephone | 248-628-1880
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Fax | 248-628-1881
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Provider Business Mailing Address
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Address Line | 129 S WASHINGTON ST
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City | OXFORD
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State | MI
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Zip | 48371-4981
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Country | US
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Telephone | 248-628-1880
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Fax | 248-628-1881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901400128
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License Number State | MI
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