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General NPI Number Information
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NPI Number | 1720217292
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Entity Type | Individual
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Provider Name | MICHAEL MELVIN KABACK MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 4347 VISTA DE LA TIERRA
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City | DEL MAR
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State | CA
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Zip | 92014-4106
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Country | US
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Telephone | 858-259-6801
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Fax |
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Provider Business Mailing Address
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Address Line | 4347 VISTA DE LA TIERRA
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City | DEL MAR
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State | CA
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Zip | 92014-4106
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Country | US
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Telephone | 858-259-6801
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SG0202X
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Taxonomy Name | Clinical Biochemical Genetics Physician
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License Number | G23170
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License Number State | CA
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