Provider Demographics
NPI:1659347813
Name:TABAO, MICHELLE PAMPLONA (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:PAMPLONA
Last Name:TABAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:PAMPLONA
Other - Last Name:TABAO-LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1975 LIN LOR LN
Mailing Address - Street 2:SUITE 195
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4902
Mailing Address - Country:US
Mailing Address - Phone:847-468-1511
Mailing Address - Fax:847-468-1555
Practice Address - Street 1:1975 LIN LOR LN
Practice Address - Street 2:SUITE 195
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4902
Practice Address - Country:US
Practice Address - Phone:847-468-1511
Practice Address - Fax:847-468-1555
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084953208100000X
IL036-119818208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation