Provider Demographics
NPI:1427161736
Name:ABRAHAM, DENNIS JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JOEL
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 1:13005 38TH PLACE NORTH
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441
Mailing Address - Country:US
Mailing Address - Phone:612-381-6816
Mailing Address - Fax:763-488-4105
Practice Address - Street 1:13005 38TH PLACE NORTH
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441
Practice Address - Country:US
Practice Address - Phone:612-381-6816
Practice Address - Fax:763-898-1040
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0004102543OtherAETNA
FL4308850OtherCIGNA
FL47660OtherBLUE CROSS BLUE SHIELD
FL47660OtherBLUE CROSS BLUE SHIELD
FL4308850OtherCIGNA
FLK0102Medicare ID - Type UnspecifiedGROUP MEDICARE #