Provider Demographics
NPI:1649322678
Name:ABSHAGEN, STEVEN GLENN (PA)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:GLENN
Last Name:ABSHAGEN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:3264 N EVERGREEN DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9746
Mailing Address - Country:US
Mailing Address - Phone:616-363-7339
Mailing Address - Fax:616-361-5828
Practice Address - Street 1:3304 COOLEY CT
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-7430
Practice Address - Country:US
Practice Address - Phone:269-349-2266
Practice Address - Fax:269-349-0792
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2018-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004208363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1053912070OtherBLUE CROSS BLUE SHIELD
MI1851569958OtherBLUE CROSS BLUE SHIELD
MI1851569958OtherCOMMERCIAL
MA1036931OtherCONTRULLED SUBSTANCE
MI1649322678OtherNPI
MI100C914640OtherBLUE CROSS BLUE SHIELD
MI1417961137OtherBCBSM - BRONSON
MI1649322678OtherBLUE CROSS BLUE SHIELD
MI1649322678OtherCOMMERCIAL
MI261859452OtherBLUE CROSS BLUE SHIELD
MI261859452OtherCOMMERCIAL
MI1649322678Medicaid
MI5601004208OtherPHYSICIAN ASSISTANTS LICE
MI1649322678OtherBLUE CROSS BLUE SHIELD
MI1649322678Medicaid
MI261859452Medicare PIN
MIC97618342 BRONSONMedicare PIN
MI0P56360008Medicare PIN