Basic Information
| Provider Information | |||||||||
| NPI: | 1225092208 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TABET | ||||||||
| FirstName: | JEAN-CLAUDE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 TUSCARAWAS ST W | ||||||||
| Address2: | SUITE 540 | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447084644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304540350 | ||||||||
| FaxNumber: | 3304548311 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 TUSCARAWAS ST W | ||||||||
| Address2: | SUITE 540 | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447084644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304540350 | ||||||||
| FaxNumber: | 3304548311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 45259 | OH | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2061530 | 05 | OH | MEDICAID |