Provider Demographics
NPI:1851447379
Name:MICHAEL TABA MD PA
Entity Type:Organization
Organization Name:MICHAEL TABA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:TABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-964-2626
Mailing Address - Street 1:1705 OHIO DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5255
Mailing Address - Country:US
Mailing Address - Phone:972-758-3595
Mailing Address - Fax:972-599-9604
Practice Address - Street 1:7 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7829
Practice Address - Country:US
Practice Address - Phone:972-964-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDO0757OtherRAILROAD
TX194743401Medicaid
TX288715001Medicaid
TX0024PUOtherBCBS
TX0024PUOtherBCBS
TXTXB143550Medicare PIN