Basic Information
| Provider Information | |||||||||
| NPI: | 1982059242 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TABB | ||||||||
| FirstName: | CARL | ||||||||
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| NameSuffix: | II | ||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY PEDIATRICIANS | ||||||||
| Address2: | 4201 ST. ANTOINE UHC 5D - MAILBOX 226 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139665051 | ||||||||
| FaxNumber: | 3139660665 | ||||||||
| Practice Location | |||||||||
| Address1: | CHILDREN'S HOSPITAL OF MI | ||||||||
| Address2: | 3901 BEAUBUEN | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137455638 | ||||||||
| FaxNumber: | 3137455867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2016 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301119065 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080N0001X | 4301119065 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.