Healthcare Provider Details

I. General information

NPI: 1477535193
Provider Name (Legal Business Name): DANIEL B AZABACHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 N SKEEL AVE
OSCODA MI
48750-1535
US

IV. Provider business mailing address

5671 N SKEEL AVE
OSCODA MI
48750-1535
US

V. Phone/Fax

Practice location:
  • Phone: 989-739-2550
  • Fax: 989-358-3750
Mailing address:
  • Phone: 989-739-2550
  • Fax: 989-358-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301084673
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: