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General NPI Number Information
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NPI Number | 1891828885
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Entity Type | Organization
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Legal Business Name | ABODE INTEGRATED MEDICINE,PLLC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 25500 MEADOWBROOK RD # 215
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City | NOVI
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State | MI
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Zip | 48375-1845
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Country | US
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Telephone | 248-888-9780
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Fax | 248-888-9784
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Provider Business Mailing Address
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Address Line | 25500 MEADOWBROOK RD # 215
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City | NOVI
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State | MI
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Zip | 48375-1845
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Country | US
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Telephone | 248-888-9780
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Fax | 248-888-3184
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Authorized Official
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Title or Position | PRESDENT
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Name | DR. JAY BRAIN DANTO
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Credential | D.O.
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Telephone | 248-888-9780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State |
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