Basic Information
| Provider Information | |||||||||
| NPI: | 1285661546 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KREPOSTMAN | ||||||||
| FirstName: | ABRAHAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 S WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486012556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897543349 | ||||||||
| FaxNumber: | 9897551365 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 E WARWICK DR | ||||||||
| Address2: | SUITE E | ||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488011083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894630672 | ||||||||
| FaxNumber: | 9894665116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 01/10/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 4301054975 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1007179 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 1006845 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 4943515 | 05 | MI | MEDICAID | 1102900191 | 01 | MI | BCBSM | OTHER |