Provider Demographics
NPI:1255440095
Name:SALACATA, ABRAHAM S (MD)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:S
Last Name:SALACATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 LONG RAPIDS PLZ
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1442
Mailing Address - Country:US
Mailing Address - Phone:989-356-0141
Mailing Address - Fax:989-354-5670
Practice Address - Street 1:460 LONG RAPIDS PLZ
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1442
Practice Address - Country:US
Practice Address - Phone:989-356-0141
Practice Address - Fax:989-354-5670
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIAS056672207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISA056672OtherSTATE LICENSE NUMBER
MI4541395Medicaid
MIN75350001Medicare ID - Type UnspecifiedMEDICARE NUMBER
MIG53509Medicare UPIN