MEDICARE: NUMA P. CABRERA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center	4301035433	MI

General Provider Information

NPI Number	:	1376732081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUMA P. CABRERA M.D.

Provider Business Mailing Address
First Line	:	2115 CHURCHILL DR
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-6000
Country	:	US
Telephone Number	:	734-996-0441
Fax Number	:

Provider Business Practice Location Address
First Line	:	1780 E PARNALL RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-7136
Country	:	US
Telephone Number	:	517-780-6722
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. NUMA P. CABRERA
Credential	:	M.D.
Telephone Number	:	517-780-6722

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/18/2007

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