Healthcare Provider Details

I. General information

NPI: 1891887048
Provider Name (Legal Business Name): KAMEL ABRAHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E HOME RD
SPRINGFIELD OH
45503-2725
US

IV. Provider business mailing address

3066 KETTERING BLVD
MORAINE OH
45439-1960
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-5333
  • Fax: 937-298-5923
Mailing address:
  • Phone: 937-342-1619
  • Fax: 937-390-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35054847
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number35054847
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: