Provider Demographics
NPI:1891828885
Name:ABODE INTEGRATED MEDICINE,PLLC
Entity Type:Organization
Organization Name:ABODE INTEGRATED MEDICINE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:BRAIN
Authorized Official - Last Name:DANTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-888-9780
Mailing Address - Street 1:25500 MEADOWBROOK RD
Mailing Address - Street 2:# 215
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1845
Mailing Address - Country:US
Mailing Address - Phone:248-888-9780
Mailing Address - Fax:248-888-3184
Practice Address - Street 1:25500 MEADOWBROOK RD
Practice Address - Street 2:# 215
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1845
Practice Address - Country:US
Practice Address - Phone:248-888-9780
Practice Address - Fax:248-888-9784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty