Provider Demographics
NPI:1285669671
Name:ABE, MICHIO (MD)
Entity Type:Individual
Prefix:
First Name:MICHIO
Middle Name:
Last Name:ABE
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 1:12370 HESPERIA RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7719
Mailing Address - Country:US
Mailing Address - Phone:760-245-4747
Mailing Address - Fax:
Practice Address - Street 1:12408 HESPERIA RD
Practice Address - Street 2:SUITE 21
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7718
Practice Address - Country:US
Practice Address - Phone:760-553-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01363664OtherRAILROAD MEDICARE-DU4032; DU4034
CAAPPROVEDMedicaid
CAI49050Medicare UPIN
CAAPPROVEDMedicaid
CACA118915Medicare PIN