MEDICARE: ENOCH A TABB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1316799810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENOCH A TABB

Provider Business Mailing Address
First Line	:	16133 HUBBELL ST APT 1
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-4027
Country	:	US
Telephone Number	:	313-918-4537
Fax Number	:

Provider Business Practice Location Address
First Line	:	19300 LAUDER ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-1942
Country	:	US
Telephone Number	:	313-918-4537
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2024
Last Update Date	:	04/05/2024

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Directions to “ ENOCH A TABB ” Practice Location

Language	Start Address	Practice Location

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