Provider Demographics
NPI:1689745481
Name:ALTARES, EDGAR ABUYAN (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:ABUYAN
Last Name:ALTARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:STE 270
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6122
Mailing Address - Country:US
Mailing Address - Phone:248-853-2223
Mailing Address - Fax:248-853-4300
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:STE 150
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6122
Practice Address - Country:US
Practice Address - Phone:248-853-6300
Practice Address - Fax:248-853-6303
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104860969Medicaid
MI0F32365OtherBCBS
MIF97554Medicare UPIN
MI0F32365OtherBCBS