Healthcare Provider Details

I. General information

NPI: 1437916210
Provider Name (Legal Business Name): ABIGAIL MAGUAD BALUYOT AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11275 ALLEN RD
SOUTHGATE MI
48195-3380
US

IV. Provider business mailing address

8213 HUNTERS RIDGE DR
NEWPORT MI
48166-7837
US

V. Phone/Fax

Practice location:
  • Phone: 313-383-7071
  • Fax:
Mailing address:
  • Phone: 734-394-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704282146
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: