Individual
ETHAN ALI TABAIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 E SUPERIOR ST, CHICAGO, IL 60611-4494
(312) 503-8194
Mailing address
9700 W TARON DR, ELK GROVE, CA 95757-8145
(916) 686-7300
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
Y3980256
CA
Other
Enumeration date
03/11/2025
Last updated
03/11/2025
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