Healthcare Provider Details

I. General information

NPI: 1033104971
Provider Name (Legal Business Name): ABRAHAM M OBUCHOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 SOUTH CONGRESS AVE
ATLANTIS FL
33462
US

IV. Provider business mailing address

7700 WEST SUNRISE BLVD
PLANTATION FL
33322
US

V. Phone/Fax

Practice location:
  • Phone: 561-548-3727
  • Fax: 561-548-1238
Mailing address:
  • Phone: 866-957-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberME109182
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME109182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: