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General NPI Number Information
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NPI Number | 1184620908
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Entity Type | Individual
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Provider Name | KENDALL P. TABOR DPM, FACFS
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 1414 W FAIR AVE STE 215
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City | MARQUETTE
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State | MI
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Zip | 49855-2675
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Country | US
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Telephone | 906-225-7709
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Fax | 906-225-7707
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Provider Business Mailing Address
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Address Line | 515 HOWARD ST STE 215
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City | KALAMAZOO
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State | MI
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Zip | 49008-1917
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Country | US
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Telephone | 269-385-1000
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Fax | 269-385-5120
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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 | 5901001089
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901001089
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License Number State | MI
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