Healthcare Provider Details

I. General information

NPI: 1578641833
Provider Name (Legal Business Name): ERIK CHARLES CABBLE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 DEXTER ANN ARBOR RD
DEXTER MI
48130-8598
US

IV. Provider business mailing address

3621 S STATE ST
ANN ARBOR MI
48108-1633
US

V. Phone/Fax

Practice location:
  • Phone: 734-426-2796
  • Fax: 734-426-4370
Mailing address:
  • Phone: 734-647-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003777
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: