Basic Information
| Provider Information | |||||||||
| NPI: | 1033104971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBUCHOWSKI | ||||||||
| FirstName: | ABRAHAM | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7700 WEST SUNRISE BLVD | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669578399 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5301 SOUTH CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615483727 | ||||||||
| FaxNumber: | 5615481238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 03/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170100000X | ME109182 | FL | N | Other Service Providers | Medical Genetics, Ph.D. Medical Genetics | 2085N0700X | ME109182 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
ID Information
| ID | Type | State | Issuer | Description | KK383 | 01 | FL | FL HFMG MEDICARE | OTHER | 14C42 | 01 | FL | BC/BS | OTHER | P02366621 | 01 | FL | FL MEDICARE | OTHER | 3305800 | 05 | FL | MEDICAID |