Provider Demographics
NPI:1275630501
Name:ABBOTT, CATHLEEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:M
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:804 SERVICE RD # A201
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:804 SERVICE RD
Practice Address - Street 2:ROOM A142
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-1313
Practice Address - Country:US
Practice Address - Phone:517-353-3050
Practice Address - Fax:517-432-3742
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301056286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4230368Medicaid
MI1275630501Medicaid
F37596Medicare UPIN
MI1275630501Medicaid