MEDICARE: DR. ANTHONY E ABANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician	38573	KY
2	225400000X	Rehabilitation Practitioner	38573	KY
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	38573	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548250525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY E ABANG M.D.

Provider Business Mailing Address
First Line	:	1811 N DIXIE AVE, STE 104, PMB 130
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-5564
Country	:	US
Telephone Number	:	270-360-0008
Fax Number	:	270-360-0141

Provider Business Practice Location Address
First Line	:	2005 NORTH DIXIE AVENUE
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-2526
Country	:	US
Telephone Number	:	270-360-0008
Fax Number	:	270-360-0141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	01/02/2020

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