Healthcare Provider Details

I. General information

NPI: 1881677680
Provider Name (Legal Business Name): MICK ABAE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N PINE ISLAND RD SUITE# I
PLANTATION FL
33324-1840
US

IV. Provider business mailing address

201 N PINE ISLAND RD SECOND FLOOR
PLANTATION FL
33324-1840
US

V. Phone/Fax

Practice location:
  • Phone: 954-584-2273
  • Fax: 954-587-9630
Mailing address:
  • Phone: 954-584-2273
  • Fax: 954-587-9630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberME60217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: