Provider Demographics
NPI:1598792723
Name:ABRAMS, VIVIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1765
Mailing Address - Country:US
Mailing Address - Phone:972-548-0002
Mailing Address - Fax:972-562-5556
Practice Address - Street 1:4201 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 290
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1765
Practice Address - Country:US
Practice Address - Phone:972-548-0002
Practice Address - Fax:972-562-5556
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018631401Medicaid
BM18Medicare ID - Type Unspecified
T11862Medicare UPIN