Individual
DR. EDGAR VINCENT TABILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
27450 SCHOENHERR RD, SUITE 400, WARREN, MI 48088-6683
(586) 582-7550
Mailing address
PHR GROUP PROVIDER ENROLLMENT UNIT 3RD FL, 393 E WALNUT ST, PASADENA, CA 91188-0001
(877) 608-0044
(877) 514-0903
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
20A18381
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/23/2009
Last updated
12/07/2021
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