Healthcare Provider Details

I. General information

NPI: 1730507336
Provider Name (Legal Business Name): ZHYLDYZ KABAEVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 SPURWINK AVE
CAPE ELIZABETH ME
04107-9604
US

IV. Provider business mailing address

155 SPURWINK AVE
CAPE ELIZABETH ME
04107-9604
US

V. Phone/Fax

Practice location:
  • Phone: 207-767-2174
  • Fax:
Mailing address:
  • Phone: 207-767-2174
  • Fax:

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301105502
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD22159
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD22159
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: