Provider Demographics
NPI:1942450762
Name:ANTHONY E. ABANG, M.D., PLLC.
Entity Type:Organization
Organization Name:ANTHONY E. ABANG, M.D., PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ABANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-360-0008
Mailing Address - Street 1:2005 N DIXIE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-360-0008
Mailing Address - Fax:270-360-0141
Practice Address - Street 1:2005 N DIXIE AVENUE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-360-0008
Practice Address - Fax:270-360-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY385732081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64084692Medicaid
KYI12184Medicare UPIN
KY1956501Medicare PIN