Healthcare Provider Details

I. General information

NPI: 1215929906
Provider Name (Legal Business Name): EDUARDO ABELLANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11180 GRATIOT AVE SIUTE C
DETROIT MI
48213-1363
US

IV. Provider business mailing address

27774 FRANKLIN RD
SOUTHFIELD MI
48034-2352
US

V. Phone/Fax

Practice location:
  • Phone: 313-372-7111
  • Fax: 313-372-5509
Mailing address:
  • Phone: 248-356-5555
  • Fax: 248-356-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301049903
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: