Provider Demographics
NPI:1184605388
Name:ABBO, MARISA R (DO)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:R
Last Name:ABBO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5722 PRIORY LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1120
Mailing Address - Country:US
Mailing Address - Phone:248-229-4889
Mailing Address - Fax:
Practice Address - Street 1:2940 CROOKS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309
Practice Address - Country:US
Practice Address - Phone:248-997-9700
Practice Address - Fax:248-997-9707
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101011618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3350684Medicaid
0F37078Medicare ID - Type Unspecified
MI3350684Medicaid