MEDICARE: MINI ABRAHAM

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	133V00000X	Registered Dietitian	LD4663	OH

General Provider Information

NPI Number	:	1902377575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINI ABRAHAM

Provider Business Mailing Address
First Line	:	3053 SPARROWS CRST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-5402
Country	:	US
Telephone Number	:	330-645-7830
Fax Number	:	336-459-9385

Provider Business Practice Location Address
First Line	:	3053 SPARROWS CRST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-5402
Country	:	US
Telephone Number	:	330-645-7830
Fax Number	:	336-459-9385

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

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	12/07/2018

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Directions to “ MINI ABRAHAM ” Practice Location

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