Provider Demographics
NPI:1043488299
Name:ALBAN, PAUL THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:THOMAS
Last Name:ALBAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:16628 NORTHWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2719
Mailing Address - Country:US
Mailing Address - Phone:248-496-3537
Mailing Address - Fax:
Practice Address - Street 1:3535 PARK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3736
Practice Address - Country:US
Practice Address - Phone:231-739-2121
Practice Address - Fax:231-739-4130
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPA080049Medicaid