Provider Demographics
NPI:1669443727
Name:KACAL, MICHAEL JOHN (PA-C)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:KACAL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 34TH ST SPC 164
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3106
Mailing Address - Country:US
Mailing Address - Phone:817-219-0148
Mailing Address - Fax:
Practice Address - Street 1:6001 34TH ST SPC 164
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-3106
Practice Address - Country:US
Practice Address - Phone:817-219-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03371363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9B847AOtherHEALTHSMART PPO
TX2242884OtherUNITEDHEALTHCARE
TXP00137141OtherMEDICARE RAILROAD
TX8N4110OtherBC/BS
TXP60305Medicare UPIN
TX8N4110OtherBC/BS