Provider Demographics
NPI:1477528438
Name:ABRAHAM, PAUL ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALLAN
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:401 PHALEN BLVD
Mailing Address - Street 2:MS 41103C
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-5302
Mailing Address - Country:US
Mailing Address - Phone:651-254-7850
Mailing Address - Fax:651-254-7857
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:MAIL STOP 41103C
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7850
Practice Address - Fax:651-254-7857
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22591207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN043870700Medicaid
390000203Medicare ID - Type Unspecified
MN043870700Medicaid