Provider Demographics
NPI:1578641833
Name:CABBLE, ERIK CHARLES (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:CHARLES
Last Name:CABBLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:7300 DEXTER ANN ARBOR RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-8598
Practice Address - Country:US
Practice Address - Phone:734-426-2796
Practice Address - Fax:734-426-4370
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003777363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP19056Medicare UPIN
MI0M52870068Medicare ID - Type Unspecified