MEDICARE: DR. CARMELO CABALU MENDIOLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	00017265	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	510-03718	OTHER	AL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	515-34925	OTHER	AL	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023063922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMELO CABALU MENDIOLA MD

Provider Business Mailing Address
First Line	:	2202 JORDAN ROAD SW
Second Line	:	SUITE 500
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3688
Country	:	US
Telephone Number	:	256-844-2825
Fax Number	:	256-844-2834

Provider Business Practice Location Address
First Line	:	2202 JORDAN ROAD SW
Second Line	:	SUITE 500
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3688
Country	:	US
Telephone Number	:	256-844-2825
Fax Number	:	256-844-2834

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	01/27/2009

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