Provider Demographics
NPI:1518090299
Name:VAHAGN AGBABIAN DO PC
Entity Type:Organization
Organization Name:VAHAGN AGBABIAN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VAHAGN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-334-2424
Mailing Address - Street 1:28 N SAGINAW ST
Mailing Address - Street 2:SUITE 703
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2134
Mailing Address - Country:US
Mailing Address - Phone:248-334-2424
Mailing Address - Fax:248-334-2924
Practice Address - Street 1:28 N SAGINAW ST
Practice Address - Street 2:SUITE 703
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2134
Practice Address - Country:US
Practice Address - Phone:248-334-2424
Practice Address - Fax:248-334-2924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101004232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013961Medicaid
MI115789986OtherRR MEDICARE
MI1156300095OtherBC OF MICHIGAN
MI=========OtherCOMMERCIAL
MIE26840Medicare UPIN
MI=========OtherCOMMERCIAL