Provider Demographics
NPI:1669643896
Name:ADONAI DIABETES AND ENDOCRINOLOGY CENTER
Entity Type:Organization
Organization Name:ADONAI DIABETES AND ENDOCRINOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-357-2332
Mailing Address - Street 1:3331 E MERIDIAN PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7299
Mailing Address - Country:US
Mailing Address - Phone:907-357-8006
Mailing Address - Fax:
Practice Address - Street 1:3331 E MERIDIAN PARK LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7299
Practice Address - Country:US
Practice Address - Phone:907-357-8006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-15
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4646207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK161702Medicare PIN