Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | DO199989 | OR |
N | 207VX0000X | Obstetrician | 5101012996 | MI |
NPI | 1396843538 |
---|---|
Provider Name | Peter Cabala |
First Address | Flint, MI 48503-5004 |
Second Address | Flint, MI 48503-5004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114328964 | (05) | MI |
160B576250 | BLUE CROSS BLUE SHIELD (01) | MI |
H35535 | (02) | MI |