Provider Demographics
NPI:1215928791
Name:CABE, EMMANUEL C (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:C
Last Name:CABE
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 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3516
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7980 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4170
Practice Address - Country:US
Practice Address - Phone:260-436-6765
Practice Address - Fax:260-436-7836
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040740A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000091880OtherBLUE CROSS BLUE SHIELD
IN100318020Medicaid
INM400048084Medicare PIN
000000091880OtherBLUE CROSS BLUE SHIELD
IN100318020Medicaid
000000000821OtherMPLAN
1141OtherPHYSICIANS HEALTH PLAN
IN925500JMedicare PIN
INM400048084Medicare PIN