Provider Demographics
NPI:1528358983
Name:NAVRATIL, ABBY LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:LOUISE
Last Name:NAVRATIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5400 FORT ST STE 150
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-4627
Practice Address - Country:US
Practice Address - Phone:734-671-3678
Practice Address - Fax:734-671-3679
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099239208600000X, 208600000X
NC201601008208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2805Medicaid
NC1528358983Medicaid
NCNCT506BMedicare PIN