Provider Demographics
NPI:1700997574
Name:FAITH ABBOTT DO PLC
Entity type:Organization
Organization Name:FAITH ABBOTT DO PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-781-2232
Mailing Address - Street 1:7326 GRATIOT RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-6909
Mailing Address - Country:US
Mailing Address - Phone:989-781-2232
Mailing Address - Fax:989-781-2399
Practice Address - Street 1:7326 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48609-6909
Practice Address - Country:US
Practice Address - Phone:989-781-2232
Practice Address - Fax:989-781-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011271174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI130026094OtherRAIL ROAD MEDICARE
MI1357300535OtherBLUE CROSS
MI0980954OtherHEALTHPLUS
MI1357300535OtherBLUE CARE NETWORK
MI4475683Medicaid
MI0P21090Medicare PIN
MI1357300535OtherBLUE CROSS