Provider Demographics
NPI:1861586463
Name:ABY, ROBERT D (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:ABY
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:PO BOX 731
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-0731
Mailing Address - Country:US
Mailing Address - Phone:507-646-8964
Mailing Address - Fax:952-516-5300
Practice Address - Street 1:2980 130TH ST E
Practice Address - Street 2:
Practice Address - City:DUNDAS
Practice Address - State:MN
Practice Address - Zip Code:55019-4231
Practice Address - Country:US
Practice Address - Phone:507-646-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN48017ABOtherBCBS MPIN
IA1972349Medicaid
MN110164898OtherRR MEDICARE
MN125546OtherUCARE
MN614385700Medicaid
MN110164898OtherRR MEDICARE
MN125546OtherUCARE