1689669087 NPI number — DR. GAIL ABRAHAM MD

Table of content: DR. GAIL ABRAHAM MD (NPI 1689669087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689669087 NPI number — DR. GAIL ABRAHAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABRAHAM
Provider First Name:
GAIL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1689669087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2055 E 14 MILE RD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48009-7256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-645-1740
Provider Business Mailing Address Fax Number:
248-645-5304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2055 E 14 MILE RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48009-7256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-645-1740
Provider Business Practice Location Address Fax Number:
248-645-5304
Provider Enumeration Date:
09/13/2005

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:  GA045119 , 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: 109392 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: F42105 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4726907 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103558 . This is a "GLHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4312393 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P90965 . This is a "BCN OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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