Provider Demographics
NPI:1336199975
Name:ABALO, TOMAS WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:WILLIAM
Last Name:ABALO
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 1:305 SCENIC CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7196
Mailing Address - Country:US
Mailing Address - Phone:989-941-1358
Mailing Address - Fax:
Practice Address - Street 1:325 E H ST
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4760
Practice Address - Country:US
Practice Address - Phone:906-774-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10097207R00000X
MI4301073402207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110217938OtherMETRAHEALTH RR
MI0987559OtherHEALTHPLUS
MI3524658Medicaid
MI1108273981OtherBCBS
MI382567464052OtherCOMMUNITY CHOICE MI
MIP00261665OtherMETRAHEALTH RR
MI1108273981OtherBCBS
MIP00261665OtherMETRAHEALTH RR
MIN98700005Medicare ID - Type Unspecified