Provider Demographics
NPI:1912345737
Name:ABBOTT, EMILY EUBANKS (DO, MS)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:EUBANKS
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11012 E 13 MILE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2546
Mailing Address - Country:US
Mailing Address - Phone:586-751-3380
Mailing Address - Fax:
Practice Address - Street 1:11012 E 13 MILE RD STE 112
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2546
Practice Address - Country:US
Practice Address - Phone:586-751-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019817208600000X
MI51010206172086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No208600000XAllopathic & Osteopathic PhysiciansSurgery