Provider Demographics
NPI:1568014884
Name:IGNATIUS, ABEL JOHN (MD)
Entity Type:Individual
Prefix:MR
First Name:ABEL
Middle Name:JOHN
Last Name:IGNATIUS
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 1:2799 W. GRAND BLVD.
Mailing Address - Street 2:CFP 046
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-916-8212
Mailing Address - Fax:313-916-2018
Practice Address - Street 1:2799 W. GRAND BLVD.
Practice Address - Street 2:CFP 046
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-916-8212
Practice Address - Fax:313-916-2018
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2020-03-03
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-03-03
Provider Licenses
StateLicense IDTaxonomies
MI4351044602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine