Provider Demographics
NPI:1124098694
Name:CABALA, ALBERT A (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:A
Last Name:CABALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5629 STADIUM DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1952
Mailing Address - Country:US
Mailing Address - Phone:269-544-3270
Mailing Address - Fax:269-544-3280
Practice Address - Street 1:5629 STADIUM DR
Practice Address - Street 2:SUITE B
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1952
Practice Address - Country:US
Practice Address - Phone:269-544-3270
Practice Address - Fax:269-544-3288
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4352404Medicaid
MICA4396OtherRAILROAD MEDICARE
MICA4396OtherRAILROAD MEDICARE
MI4352404Medicaid