Provider Demographics
NPI:1467810382
Name:MICHAEL J KACAL PC
Entity Type:Organization
Organization Name:MICHAEL J KACAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KACAL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:817-219-0148
Mailing Address - Street 1:7014 KACAL RD
Mailing Address - Street 2:
Mailing Address - City:BEASLEY
Mailing Address - State:TX
Mailing Address - Zip Code:77417-9740
Mailing Address - Country:US
Mailing Address - Phone:817-219-0148
Mailing Address - Fax:
Practice Address - Street 1:7014 KACAL RD
Practice Address - Street 2:
Practice Address - City:BEASLEY
Practice Address - State:TX
Practice Address - Zip Code:77417-9740
Practice Address - Country:US
Practice Address - Phone:817-219-0148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-06
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03371363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2242884OtherUNITED HEALTHCARE
TX9B847AOtherHEALTHSMART
TX8N4110OtherBCBS
TXP00137141OtherMEDICARE RAILROAD