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General NPI Number Information
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NPI Number | 1093901795
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Entity Type | Organization
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Legal Business Name | BRUCE TABAK, D.P.M.
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Dates
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Enumeration Date | 09/18/2007
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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 | OWNER
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Name | DR. BRUCE TABAK
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Credential | D.P.M.
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Telephone | 248-628-1880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 5901400128
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License Number State | MI
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