Provider Demographics
NPI:1295005627
Name:TAUB, ALICIA KING (RD)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:KING
Last Name:TAUB
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 IRVINE LN
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2951
Mailing Address - Country:US
Mailing Address - Phone:313-469-6867
Mailing Address - Fax:
Practice Address - Street 1:161 IRVINE LN
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-2951
Practice Address - Country:US
Practice Address - Phone:313-469-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered