Provider Demographics
NPI:1679751317
Name:WEST KY ABRAMS DO PA
Entity Type:Organization
Organization Name:WEST KY ABRAMS DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WEST-KY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-431-1904
Mailing Address - Street 1:1951 SW 172ND AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5593
Mailing Address - Country:US
Mailing Address - Phone:954-431-1904
Mailing Address - Fax:954-431-1914
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE #308
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:954-431-1904
Practice Address - Fax:954-431-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7528Medicare PIN