Provider Demographics
NPI:1306874920
Name:ABRAHAM, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:ABRAHAM
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 1:1720 HIGHWAY 59 S
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-4331
Mailing Address - Country:US
Mailing Address - Phone:218-681-4747
Mailing Address - Fax:218-683-2595
Practice Address - Street 1:1720 HIGHWAY 59 S
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-4331
Practice Address - Country:US
Practice Address - Phone:218-681-4747
Practice Address - Fax:218-683-2595
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45176207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12208Medicaid
MN64G77ABOtherMNBS #
MNHP38297OtherHEALTHPARTNERS #
MN1000386OtherMEDICA #
MN1000692OtherMEDICA #
MN169872OtherUCARE #
MN22280OtherNDBS #
MN317S2ABOtherMNBS #
MN121635000Medicaid
MN1642950OtherAMERICA'S PPO/ARAZ #
MNDA9021032617OtherPREFERRED ONE #
MNDA9071032617OtherPREFERRED ONE #
MN25842OtherNDBS #
MN1642950OtherAMERICA'S PPO/ARAZ #
MNP00255212Medicare ID - Type UnspecifiedRR MEDICARE #
MNDA9021032617OtherPREFERRED ONE #
MN317S2ABOtherMNBS #
MN040017648Medicare ID - Type UnspecifiedRR MEDICARE #
MN040000878Medicare PIN