Provider Demographics
NPI:1689281180
Name:ABANE, MICHAEL ANTEM
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTEM
Last Name:ABANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11018 N MAY AVE APT 218
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-6310
Mailing Address - Country:US
Mailing Address - Phone:405-412-9219
Mailing Address - Fax:
Practice Address - Street 1:11018 N MAY AVE APT 218
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6310
Practice Address - Country:US
Practice Address - Phone:405-412-9219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator