Provider Demographics
NPI:1548250525
Name:ABANG, ANTHONY E (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:E
Last Name:ABANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 N DIXIE AVE, STE 104, PMB 130
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-5564
Mailing Address - Country:US
Mailing Address - Phone:270-360-0008
Mailing Address - Fax:270-360-0141
Practice Address - Street 1:2005 NORTH DIXIE AVENUE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2526
Practice Address - Country:US
Practice Address - Phone:270-360-0008
Practice Address - Fax:270-360-0141
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38573208VP0000X, 225400000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64084692Medicaid
KYI12184Medicare UPIN