Provider Demographics
NPI:1447254248
Name:ABIRAGI, VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:ABIRAGI
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 1:25631 LITTLE MACK
Mailing Address - Street 2:STE 201
Mailing Address - City:ST. CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2108
Mailing Address - Country:US
Mailing Address - Phone:586-443-2930
Mailing Address - Fax:586-443-2958
Practice Address - Street 1:25631 LITTLE MACK
Practice Address - Street 2:STE 201
Practice Address - City:ST. CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2108
Practice Address - Country:US
Practice Address - Phone:586-443-2930
Practice Address - Fax:586-443-2958
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E01050OtherBCBS GROUP
MI4901239Medicaid
MI0509054OtherBCBS INDIVIDUAL PIN
MI4018153OtherAETNA
MIA76893Medicare UPIN
MIM25330006Medicare PIN
MI4018153OtherAETNA