Healthcare Provider Details

I. General information

NPI: 1891828885
Provider Name (Legal Business Name): ABODE INTEGRATED MEDICINE,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 MEADOWBROOK RD # 215
NOVI MI
48375-1845
US

IV. Provider business mailing address

25500 MEADOWBROOK RD # 215
NOVI MI
48375-1845
US

V. Phone/Fax

Practice location:
  • Phone: 248-888-9780
  • Fax: 248-888-9784
Mailing address:
  • Phone: 248-888-9780
  • Fax: 248-888-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY BRAIN DANTO
Title or Position: PRESDENT
Credential: D.O.
Phone: 248-888-9780