MEDICARE: SUZANNE ABRAHAM DPM

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	213E00000X	Podiatrist	0609	AZ

General Provider Information

NPI Number	:	1982655957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE ABRAHAM DPM

Provider Business Mailing Address
First Line	:	1701 E THOMAS RD
Second Line	:	SUITE 201
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7646
Country	:	US
Telephone Number	:	602-251-3113
Fax Number	:	602-251-3114

Provider Business Practice Location Address
First Line	:	1701 E THOMAS RD
Second Line	:	SUITE 201
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7646
Country	:	US
Telephone Number	:	602-251-3113
Fax Number	:	602-251-3114

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	01/14/2014

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