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General NPI Number Information
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NPI Number | 1003256421
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Entity Type | Individual
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Provider Name | SAMUEL ABEBE MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2013
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 5593 REDBUD CT
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City | YPSILANTI
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State | MI
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Zip | 48197-6645
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Country | US
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Telephone | 734-846-2547
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Fax |
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Provider Business Mailing Address
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Address Line | 5593 REDBUD CT
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City | YPSILANTI
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State | MI
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Zip | 48197-6645
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Country | US
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Telephone | 734-846-2547
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | M-1987
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License Number State | GU
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A144270
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301110841
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License Number State | MI
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