Provider Demographics
NPI:1134407430
Name:ABLA, EYAS (MD,)
Entity type:Individual
Prefix:
First Name:EYAS
Middle Name:
Last Name:ABLA
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 1:1900 CENTRACARE CIR # 1300
Mailing Address - Street 2:CENTRACARE CLINIC WOMEN & CHILDREN, ALLERGY/IMMUNOLOGY
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3650
Mailing Address - Fax:320-654-3647
Practice Address - Street 1:1900 CENTRACARE CIR # 1300
Practice Address - Street 2:CENTRACARE CLINIC WOMEN & CHILDREN, ALLERGY/IMMUNOLOGY
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3650
Practice Address - Fax:320-654-3647
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN108882207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine