1508178393 NPI number — TINTIN LLENA MANUELA ABAD M.D.

Table of content: TINTIN LLENA MANUELA ABAD M.D. (NPI 1508178393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508178393 NPI number — TINTIN LLENA MANUELA ABAD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANUELA ABAD
Provider First Name:
TINTIN
Provider Middle Name:
LLENA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508178393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6297 BOULDER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48433-3538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-877-1420
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HURLEY PLZ
Provider Second Line Business Practice Location Address:
SON 5TH FLOOR
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48503-5902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-262-9773
Provider Business Practice Location Address Fax Number:
810-262-7143
Provider Enumeration Date:
07/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  4301096036 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4301096036 . This is a "STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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