Healthcare Provider Details

I. General information

NPI: 1912345737
Provider Name (Legal Business Name): EMILY EUBANKS ABBOTT D.O., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11012 E 13 MILE RD STE 112
WARREN MI
48093-2546
US

IV. Provider business mailing address

11012 E 13 MILE RD STE 112
WARREN MI
48093-2546
US

V. Phone/Fax

Practice location:
  • Phone: 586-751-3380
  • Fax:
Mailing address:
  • Phone: 586-751-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS019817
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number5101020617
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: