Provider Demographics
NPI:1306922000
Name:TABONE, ANTHONY M (PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:TABONE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4379 REYCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-9352
Mailing Address - Country:US
Mailing Address - Phone:231-622-2706
Mailing Address - Fax:
Practice Address - Street 1:4379 REYCRAFT RD
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-9352
Practice Address - Country:US
Practice Address - Phone:231-622-2706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601004827OtherMICHIGAN LICENSE
MI0P52980Medicare PIN