Individual
DR. BRUCE TABAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
129 S WASHINGTON ST, OXFORD, MI 48371-4981
(248) 628-1880
(248) 628-1881
Mailing address
129 S WASHINGTON ST, OXFORD, MI 48371-4981
(248) 628-1880
(248) 628-1881
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
5901400128
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1648173
—
MI
05
—
3142556
—
MI
01
—
5635090
BLUE CROSS OF MICHIGAN
MI
Enumeration date
11/14/2006
Last updated
07/23/2012
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