Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301046525 | MI |
N | 207PE0004X | Emergency Medical Services | 4301046525 | MI |
NPI | 1205873445 |
---|---|
Provider Name | Dr. Ross E Tabbey |
First Address | Dearborn Heights, MI 48127-3453 |
Second Address | Detroit, MI 48201-2153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 17/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101988550 | (05) | MI |
104476386 | (05) | MI |
B45651 | (02) | MI |
RT046525 | BC/BS OF MICHIGAN (01) | MI |