Provider Demographics
NPI:1972607422
Name:ABRAHAM, THOMAS ABEY (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ABEY
Last Name:ABRAHAM
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 1:5020 LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3382
Mailing Address - Country:US
Mailing Address - Phone:269-381-1864
Mailing Address - Fax:
Practice Address - Street 1:5020 LAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3382
Practice Address - Country:US
Practice Address - Phone:269-381-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITA036531207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4830001OtherPHP
MI1386418Medicaid
MI290C96034OtherBC/BS OF MICHIGAN
MI382356205106OtherCOMMUNITY CHOICE OF MICH
118361OtherGRT LAKES HLTH PLAN
MI290006922OtherRAILROAD MEDICARE
290C913410OtherBCBS GRP PIN
MI4986915Medicaid
290390013OtherBCBS IND PIN
4379445OtherAETNA
MIP00606307OtherRAILROAD MEDICARE
4809115OtherPHP
MIP55003OtherBLUECARE NETWORK
4379445OtherAETNA
118361OtherGRT LAKES HLTH PLAN
MI0C96034001Medicare ID - Type Unspecified