Provider Demographics
NPI:1740289487
Name:ABBOTT, VALERIE (MD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
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:PO BOX 441755
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-1755
Mailing Address - Country:US
Mailing Address - Phone:248-742-0400
Mailing Address - Fax:
Practice Address - Street 1:19830 JAMES COUZENS FWY
Practice Address - Street 2:SUITE B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1938
Practice Address - Country:US
Practice Address - Phone:313-341-4800
Practice Address - Fax:313-341-4848
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4277758Medicaid
MI1108252262OtherBCBS BCN
MI1108297761OtherBCN
MI1108297761OtherBCBS
MI1108252262OtherBCBS BCN
MI0N92410001Medicare PIN