Provider Demographics
NPI:1508903543
Name:SABO, MICHAEL J (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:SABO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N JOHN REDDITT DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-2606
Mailing Address - Country:US
Mailing Address - Phone:936-632-5252
Mailing Address - Fax:936-632-5284
Practice Address - Street 1:300 N JOHN REDDITT DR
Practice Address - Street 2:SUITE 4
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-2606
Practice Address - Country:US
Practice Address - Phone:936-632-5252
Practice Address - Fax:936-632-5284
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0540213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15696Medicare UPIN
TX8215B6Medicare ID - Type Unspecified