Provider Demographics
NPI:1437126489
Name:CABBABE, EDMOND B (MD)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:B
Last Name:CABBABE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 KENNERLY RD STE 283B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2177
Mailing Address - Country:US
Mailing Address - Phone:314-272-0864
Mailing Address - Fax:314-272-0866
Practice Address - Street 1:10004 KENNERLY RD STE 281B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2109
Practice Address - Country:US
Practice Address - Phone:314-842-5885
Practice Address - Fax:314-842-7792
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8454208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A12871Medicare UPIN
001010563Medicare PIN
240002063Medicare PIN