Provider Demographics
NPI:1811082092
Name:KENNETH C CABLE MD PLLC
Entity type:Organization
Organization Name:KENNETH C CABLE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-789-2039
Mailing Address - Street 1:PO BOX 13837
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-3837
Mailing Address - Country:US
Mailing Address - Phone:480-789-2039
Mailing Address - Fax:480-595-9862
Practice Address - Street 1:39810 N 105TH WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-3314
Practice Address - Country:US
Practice Address - Phone:480-789-2039
Practice Address - Fax:480-595-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22364207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ111930Medicare PIN