Provider Demographics
NPI:1609495571
Name:ABRAMS, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12665 W SMOKEY DR STE 140
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-3732
Mailing Address - Country:US
Mailing Address - Phone:623-219-4040
Mailing Address - Fax:623-219-4050
Practice Address - Street 1:12665 W. SMOKEY DRIVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378
Practice Address - Country:US
Practice Address - Phone:623-219-4040
Practice Address - Fax:623-219-4050
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8154363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8154OtherARIZONA MEDICAL BOARD