Healthcare Provider Details

I. General information

NPI: 1831681113
Provider Name (Legal Business Name): TINA ABRAHAM DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2018
Last Update Date: 06/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BARCLAY CIR STE 205
ROCHESTER HILLS MI
48307-5821
US

IV. Provider business mailing address

75 BARCLAY CIR STE 205
ROCHESTER HILLS MI
48307-5821
US

V. Phone/Fax

Practice location:
  • Phone: 248-651-6430
  • Fax:
Mailing address:
  • Phone: 248-651-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number5101020319
License Number StateMI

VIII. Authorized Official

Name: TINA ABRAHAM
Title or Position: OWNER
Credential: DO
Phone: 248-651-6430