MEDICARE: DR. MATTHEW MACK ABRAHAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	024082	LA
2	207QS1201X	Sleep Medicine (Family Medicine) Physician	024082	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174511794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW MACK ABRAHAM M.D.

Provider Business Mailing Address
First Line	:	2851 JOHNSTON STREET
Second Line	:	PMB 517
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3243
Country	:	US
Telephone Number	:	337-561-8508
Fax Number	:	833-561-2443

Provider Business Practice Location Address
First Line	:	100 ASMA BLVD
Second Line	:	SUITE 205
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3858
Country	:	US
Telephone Number	:	337-289-5605
Fax Number	:	337-289-5609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	11/16/2023

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