Healthcare Provider Details

I. General information

NPI: 1578747093
Provider Name (Legal Business Name): KERRY MICHELLE MCCABE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 11/06/2023
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13303 RIVERSIDE DR
SHERMAN OAKS CA
91423-2508
US

IV. Provider business mailing address

13303 RIVERSIDE DR
SHERMAN OAKS CA
91423-2508
US

V. Phone/Fax

Practice location:
  • Phone: 818-722-3230
  • Fax: 818-722-3260
Mailing address:
  • Phone: 818-722-3230
  • Fax: 818-722-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A 12930
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2257
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34. 009349
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: