Healthcare Provider Details

I. General information

NPI: 1053008698
Provider Name (Legal Business Name): ABIGAIL G BADER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1742 CROOKS RD
TROY MI
48084-5501
US

IV. Provider business mailing address

1742 CROOKS RD
TROY MI
48084-5501
US

V. Phone/Fax

Practice location:
  • Phone: 248-544-0360
  • Fax: 248-544-0388
Mailing address:
  • Phone: 248-544-0360
  • Fax: 248-544-0388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: