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1649322678

NPI Code Detail

MEDICARE: MR. STEVEN GLENN ABSHAGEN P.A.

MEDICARE: MR. STEVEN GLENN ABSHAGEN P.A.

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	363A00000X	Physician Assistant	5601004208	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1053912070	OTHER	MI	BLUE CROSS BLUE SHIELD
2	1851569958	OTHER	MI	BLUE CROSS BLUE SHIELD
3	1851569958	OTHER	MI	COMMERCIAL
5	1649322678	OTHER	MI	NPI
6	100C914640	OTHER	MI	BLUE CROSS BLUE SHIELD
7	1417961137	OTHER	MI	BCBSM - BRONSON
8	1649322678	OTHER	MI	BLUE CROSS BLUE SHIELD
9	1649322678	OTHER	MI	COMMERCIAL
10	261859452	OTHER	MI	BLUE CROSS BLUE SHIELD
11	261859452	OTHER	MI	COMMERCIAL
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	5601004208	OTHER	MI	PHYSICIAN ASSISTANTS LICE

General Provider Information

NPI Number	:	1649322678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN GLENN ABSHAGEN P.A.

Provider Business Mailing Address
First Line	:	3264 N EVERGREEN DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-9746
Country	:	US
Telephone Number	:	616-363-7339
Fax Number	:	616-361-5828

Provider Business Practice Location Address
First Line	:	3304 COOLEY CT
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-7430
Country	:	US
Telephone Number	:	269-349-2266
Fax Number	:	269-349-0792

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	02/20/2018

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Directions to “ MR. STEVEN GLENN ABSHAGEN P.A.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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