1891828885 NPI number — ABODE INTEGRATED MEDICINE,PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891828885 NPI number — ABODE INTEGRATED MEDICINE,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABODE INTEGRATED MEDICINE,PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1891828885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25500 MEADOWBROOK RD
Provider Second Line Business Mailing Address:
# 215
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48375-1845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-888-9780
Provider Business Mailing Address Fax Number:
248-888-3184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25500 MEADOWBROOK RD
Provider Second Line Business Practice Location Address:
# 215
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48375-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-888-9780
Provider Business Practice Location Address Fax Number:
248-888-9784
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DANTO
Authorized Official First Name:
JAY
Authorized Official Middle Name:
BRAIN
Authorized Official Title or Position:
PRESDENT
Authorized Official Telephone Number:
248-888-9780

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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