Provider Demographics
NPI:1356419675
Name:OXHOLM-DABABNEH, AVELINA (DO)
Entity type:Individual
Prefix:
First Name:AVELINA
Middle Name:
Last Name:OXHOLM-DABABNEH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AVELINA
Other - Middle Name:
Other - Last Name:OXHOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1100 S VAN DYKE
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413
Mailing Address - Country:US
Mailing Address - Phone:989-269-9521
Mailing Address - Fax:989-269-1562
Practice Address - Street 1:1040 S VAN DYKE
Practice Address - Street 2:SUITE 1
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413
Practice Address - Country:US
Practice Address - Phone:989-269-6437
Practice Address - Fax:989-269-9162
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI70F326980OtherBCBS
MI0P22250003Medicare ID - Type Unspecified
MI70F326980OtherBCBS