Provider Demographics
NPI:1679783344
Name:RABBANI, BOBAK TAHER (MD)
Entity type:Individual
Prefix:
First Name:BOBAK
Middle Name:TAHER
Last Name:RABBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2799 W GRAND BLVD # K-14
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-3887
Mailing Address - Fax:313-916-8901
Practice Address - Street 1:2799 W GRAND BLVD # K14
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-3887
Practice Address - Fax:313-916-8901
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301085738207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E01050OtherBCBS
MI0E01050OtherBCBS