Provider Demographics
NPI:1326035650
Name:ABBOTT, FAITH (DO)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-362-9411
Mailing Address - Fax:989-362-9925
Practice Address - Street 1:4677 TOWNE CENTRE RD STE 301
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2848
Practice Address - Country:US
Practice Address - Phone:855-298-9888
Practice Address - Fax:989-497-3128
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010112712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4475683Medicaid
MI0980954OtherHEALTHPLUS
MI1357300535OtherBLUE CROSS
MI4475683Medicaid
MI0P21090Medicare ID - Type Unspecified