Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 4301080436 | MI |
NPI | 1225045024 |
---|---|
Provider Name | Bachu Abraham |
First Address | Cadillac, MI 49601-0087 |
Second Address | Mt Pleasant, MI 48858-9192 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 24/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4532476 | (05) | MI |
H71692 | (02) | |
N55780001 | (02) |