Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 085.007935 | IL |
NPI | 1003417551 |
---|---|
Provider Name | Tara Tabbaa |
First Address | Independence, OH 44131-6541 |
Second Address | Willoughby Hills, OH 44094-9607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2020 |
Last Update Date | 24/11/2021 |