Provider Demographics
NPI:1255796249
Name:PAUL, ABHILASH I
Entity type:Individual
Prefix:
First Name:ABHILASH
Middle Name:
Last Name:PAUL
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27301 SCHOENHERR RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6649
Mailing Address - Country:US
Mailing Address - Phone:586-393-5768
Mailing Address - Fax:
Practice Address - Street 1:27301 SCHOENHERR RD STE 103
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6649
Practice Address - Country:US
Practice Address - Phone:586-393-5768
Practice Address - Fax:248-282-8416
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist