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1982059242

NPI Code Detail

MEDICARE: DR. CARL TABB II MD

MEDICARE: DR. CARL TABB II MD

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	208000000X	Pediatrics Physician	D0103067	MD
2	2080N0001X	Neonatal-Perinatal Medicine Physician	D0103067	MD
3	208000000X	Pediatrics Physician	101160	GA
4	208000000X	Pediatrics Physician	A201490	CA
5	208000000X	Pediatrics Physician	35C.001714	OH
6	208000000X	Pediatrics Physician	4301119065	MI
7	2080N0001X	Neonatal-Perinatal Medicine Physician	4301119065	MI
8	2080N0001X	Neonatal-Perinatal Medicine Physician	35C.001714	OH

General Provider Information

NPI Number	:	1982059242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL TABB II MD

Provider Business Mailing Address
First Line	:	4201 ST. ANTOINE UHC 5D-MAILBOX 226
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2153
Country	:	US
Telephone Number	:	313-966-5051
Fax Number	:	313-966-0665

Provider Business Practice Location Address
First Line	:	CHILDREN'S HOSPITAL OF MI
Second Line	:	3901 BEAUBUEN
City	:	DETROIT
State	:	MI
Zip	:	48201-2119
Country	:	US
Telephone Number	:	313-745-5638
Fax Number	:	313-745-5867

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

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	02/05/2026

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Directions to “ DR. CARL TABB II MD” Practice Location

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