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General NPI Number Information
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NPI Number | 1659370724
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Entity Type | Organization
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Legal Business Name | ABBOTT MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 19830 JAMES COUZENS FWY SUITE B
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City | DETROIT
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State | MI
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Zip | 48235-1938
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Country | US
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Telephone | 313-341-4800
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Fax | 313-341-4848
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Provider Business Mailing Address
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Address Line | PO BOX 44047
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City | DETROIT
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State | MI
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Zip | 48244-0047
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Country | US
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Telephone | 313-341-4800
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Fax | 313-341-4848
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Authorized Official
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Title or Position | OWNER
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Name | DR. VALERIE ABBOTT
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Credential | MD
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Telephone | 313-341-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301060096
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License Number State | MI
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