Provider Demographics
NPI:1144406869
Name:CABATINGAN, JAIME DIAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:DIAZ
Last Name:CABATINGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4425 N PORT WASHINGTON RD
Mailing Address - Street 2:ATTN: CSMCP CLINIC CREDENTIALING
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1082
Mailing Address - Country:US
Mailing Address - Phone:262-376-1934
Mailing Address - Fax:262-375-2047
Practice Address - Street 1:2061 CHEYENNE CT
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9368
Practice Address - Country:US
Practice Address - Phone:262-376-1934
Practice Address - Fax:262-375-2076
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2012-12-03
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Provider Licenses
StateLicense IDTaxonomies
WI19401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine