Provider Demographics
NPI:1033104971
Name:OBUCHOWSKI, ABRAHAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:M
Last Name:OBUCHOWSKI
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 1:7700 WEST SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322
Mailing Address - Country:US
Mailing Address - Phone:866-957-8399
Mailing Address - Fax:
Practice Address - Street 1:5301 SOUTH CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462
Practice Address - Country:US
Practice Address - Phone:561-548-3727
Practice Address - Fax:561-548-1238
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109182170100000X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKK383OtherFL HFMG MEDICARE
FL14C42OtherBC/BS
FLP02366621OtherFL MEDICARE
FL3305800Medicaid
MDH380292XMedicare PIN
MD545L 122ZMedicare PIN
MD865L202EMedicare PIN
MDC61044Medicare UPIN
MD110800000 055201100Medicaid