Provider Demographics
NPI:1689669087
Name:ABRAHAM, GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 E 14 MILE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7256
Mailing Address - Country:US
Mailing Address - Phone:248-645-1740
Mailing Address - Fax:248-645-5304
Practice Address - Street 1:2055 E 14 MILE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7256
Practice Address - Country:US
Practice Address - Phone:248-645-1740
Practice Address - Fax:248-645-5304
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGA045119208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI109392OtherCARE CHOICES
MIF42105OtherHAP
MI4726907Medicaid
MI103558OtherGLHP
MI4312393OtherAETNA
MIP90965OtherBCN OF MICHIGAN
MIF42105Medicare UPIN