Provider Demographics
NPI:1093377582
Name:O'DARE, ABRAHAM
Entity Type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:
Last Name:O'DARE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43644 ARBORVIEW LN
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3347
Mailing Address - Country:US
Mailing Address - Phone:312-775-2318
Mailing Address - Fax:855-510-5554
Practice Address - Street 1:43644 ARBORVIEW LN
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-3347
Practice Address - Country:US
Practice Address - Phone:312-775-2318
Practice Address - Fax:855-510-5554
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIO623029027305OtherDRIVER'S LICENSE