Provider Demographics
NPI:1174963045
Name:GOMEZ HERNANDEZ, ABRAHAM ISAIAS (MD)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:ISAIAS
Last Name:GOMEZ HERNANDEZ
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 1:29201 TELEGRAPH RD
Mailing Address - Street 2:STE 324
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1331
Mailing Address - Country:US
Mailing Address - Phone:248-357-5100
Mailing Address - Fax:248-357-2548
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:STE 324
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-357-5100
Practice Address - Fax:248-357-2548
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program