NPIMap

Organization Active NPI

Kendall P. Tabor, D.P.M

  • Foot & Ankle Surgery Podiatrist
  • Marquette, MI
National Provider Identifier
1053597914
Registry record updated Dec 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
5901001089 Issued in MI
Legal business name
KENDALL P. TABOR, D.P.M
Practice address
1414 W Fair Ave
Ste 215
Marquette, MI 49855-2675
Phone
(906) 225-7709
Fax
(906) 225-7707
NPI assigned
Jan 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kendall P Tabor, D.P.M.NPI 1184620908
Title
Owner/Podiatrist
Phone
(906) 225-7709

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 5901001089 MI Primary
Durable Medical Equipment & Medical Supplies 332B00000X 5901001089 MI

Addresses

Primary practice location

1414 W Fair Ave
Ste 215
Marquette, MI 49855-2675

Mailing address

1414 W Fair Ave
Ste 215
Marquette, MI 49855-2675
Phone (906) 225-7709

Other identifiers 1

IdentifierTypeStateIssuer
2126020MedicaidMI

Other names 1

  • SUPERIOR PODIATRY ASSOCIATES, P.L.C. Other name

National Provider Directory

National Provider Directory

Locations

1414 W Fair Ave
Ste 215
Marquette, MI 49855
Phone (906) 225-3964

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9590/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324339200000",
    "number": "1053597914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE",
            "address_2": "STE 215",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552675",
            "telephone_number": "906-225-7709",
            "fax_number": "906-225-7707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE",
            "address_2": "STE 215",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552675",
            "telephone_number": "906-225-7709",
            "fax_number": "906-225-7707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENDALL P. TABOR, D.P.M",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2011-12-20",
        "status": "A",
        "authorized_official_last_name": "TABOR",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER/PODIATRIST",
        "authorized_official_telephone_number": "906-225-7709",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MI",
            "license": "5901001089",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "5901001089",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2126020",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUPERIOR PODIATRY ASSOCIATES, P.L.C.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Marquette, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.