Provider Demographics
NPI:1376665703
Name:M. THABET KARABALA, M.D., INC.
Entity Type:Organization
Organization Name:M. THABET KARABALA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:THABET
Authorized Official - Last Name:KARABALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-466-4222
Mailing Address - Street 1:940 N CENTER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1326
Mailing Address - Country:US
Mailing Address - Phone:209-466-4222
Mailing Address - Fax:209-466-3306
Practice Address - Street 1:940 N CENTER ST STE A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1326
Practice Address - Country:US
Practice Address - Phone:209-466-4222
Practice Address - Fax:209-466-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35322207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A353220Medicaid
CA00A353220Medicare ID - Type Unspecified
CA00A353220Medicaid