Provider Demographics
NPI:1609861962
Name:FABIAN, ALENA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ALENA
Middle Name:
Last Name:FABIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ALENA
Other - Middle Name:
Other - Last Name:KUBEROVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1800
Mailing Address - Country:US
Mailing Address - Phone:517-484-4451
Mailing Address - Fax:517-484-0291
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 370
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-484-4451
Practice Address - Fax:517-484-0291
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033518207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E21140Medicare UPIN
MIOC37630005Medicare ID - Type Unspecified