=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467810382
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL J KACAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2016
-----------------------------------------------------
Last Update Date | 04/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7014 KACAL RD
-----------------------------------------------------
City | BEASLEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77417-9740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-219-0148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7014 KACAL RD
-----------------------------------------------------
City | BEASLEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77417-9740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-219-0148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MICHAEL JOHN KACAL
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 817-219-0148
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA03371
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------