Provider Demographics
NPI:1255473534
Name:ABTER, ELFATIH ISMAIL I M (MD)
Entity Type:Individual
Prefix:
First Name:ELFATIH
Middle Name:ISMAIL I M
Last Name:ABTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ELFATIH
Other - Middle Name:ISMAIL M ISMAIL
Other - Last Name:ABTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-0014
Mailing Address - Country:US
Mailing Address - Phone:248-760-5812
Mailing Address - Fax:
Practice Address - Street 1:1375 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1350
Practice Address - Country:US
Practice Address - Phone:810-667-5647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05677700207RI0200X
MI4031089652207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0440074OtherBCBSM
NJ8672903Medicaid
NJ052191M26Medicare ID - Type Unspecified
NJ8672903Medicaid
MIMI3644001Medicare PIN