Provider Demographics
NPI:1871554485
Name:OOMMEN, ABRAHAM (MD)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:OOMMEN
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 1:200 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-2207
Mailing Address - Country:US
Mailing Address - Phone:989-463-5876
Mailing Address - Fax:989-466-5956
Practice Address - Street 1:200 W CENTER ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-2207
Practice Address - Country:US
Practice Address - Phone:989-463-5876
Practice Address - Fax:989-466-5956
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI031718207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1855446Medicaid
MI0293087Medicare ID - Type Unspecified
MI1855446Medicaid