Provider Demographics
NPI:1295772788
Name:TAUB, JEFFREY W (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:TAUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHILDRENS HOSPITAL OF MICHIGAN
Mailing Address - Street 2:3901 BEAUBIEN BLVD - CARDIOLOGY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-5835
Mailing Address - Fax:
Practice Address - Street 1:CHILDRENS HOSPITAL OF MICHIGAN
Practice Address - Street 2:3901 BEAUBIEN BLVD - CARDIOLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5835
Practice Address - Fax:313-993-0894
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053916208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
JT053916OtherCHAMPUS-CHAMPUS
JT053916OtherCOMMERCIAL-COMMERCIAL NUMBER
JT053916OtherCOMMERCIAL-COMMERCIAL NUMBER