Provider Demographics
NPI:1942611470
Name:DELAND, ABIGAIL (DO)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:
Last Name:DELAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:DELAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1865
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:28100 GRAND RIVER AVE STE 313
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5970
Practice Address - Country:US
Practice Address - Phone:947-521-7150
Practice Address - Fax:248-426-2473
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315064238207Q00000X
MI5101020894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine