1114971744 NPI number — DAVID WARREN KABEL MD

Table of content: DAVID WARREN KABEL MD (NPI 1114971744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114971744 NPI number — DAVID WARREN KABEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KABEL
Provider First Name:
DAVID
Provider Middle Name:
WARREN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114971744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2406 SUNSET BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR FALLS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50613-5636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2406 SUNSET BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR FALLS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50613-5636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-833-5880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  19454 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 64920 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 19262 . This is a "WELLMARK INS PLAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 2165258 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42441730712 . This is a "JOHN DEERE HEALTH INS PLA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1114971744 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1114971744 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 453836069-01 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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