Healthcare Provider Details

I. General information

NPI: 1518090299
Provider Name (Legal Business Name): VAHAGN AGBABIAN DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 N SAGINAW ST SUITE 703
PONTIAC MI
48342-2134
US

IV. Provider business mailing address

28 N SAGINAW ST SUITE 703
PONTIAC MI
48342-2134
US

V. Phone/Fax

Practice location:
  • Phone: 248-334-2424
  • Fax: 248-334-2924
Mailing address:
  • Phone: 248-334-2424
  • Fax: 248-334-2924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101004232
License Number StateMI

VIII. Authorized Official

Name: DR. VAHAGN AGBABIAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 248-334-2424