Provider Demographics
NPI:1124672654
Name:TAMBEAUX, SAMUEL GEORGE (RDN, LDN)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:GEORGE
Last Name:TAMBEAUX
Suffix:
Gender:M
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:8865 W 400 N STE 125
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9193
Practice Address - Country:US
Practice Address - Phone:219-879-0333
Practice Address - Fax:219-861-8570
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.007751133V00000X
IN37003128A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered