Provider Demographics
NPI:1316799810
Name:TABB, ENOCH A
Entity type:Individual
Prefix:
First Name:ENOCH
Middle Name:A
Last Name:TABB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16133 HUBBELL ST APT 1
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-4027
Mailing Address - Country:US
Mailing Address - Phone:313-918-4537
Mailing Address - Fax:
Practice Address - Street 1:19300 LAUDER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1942
Practice Address - Country:US
Practice Address - Phone:313-918-4537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide