Individual
BRENT TANNIN TABATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, RD
Contact information
Practice address
360 LAFAYETTE AVE SE STE 400, GRAND RAPIDS, MI 49503-4677
(616) 486-6870
(616) 454-6898
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
973751
MI
Other
Enumeration date
03/28/2023
Last updated
06/05/2023
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