Provider Demographics
NPI:1154616985
Name:ABRAHAM, HEATHER N (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:N
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:50 E CANFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1804
Mailing Address - Country:US
Mailing Address - Phone:313-745-4525
Mailing Address - Fax:313-966-7305
Practice Address - Street 1:1560 E MAPLE RD
Practice Address - Street 2:SUITE 400-CREDENTIALING
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1138
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-966-7305
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301098488207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics