Provider Demographics
NPI:1578747093
Name:MCCABE, KERRY MICHELLE (DO)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:MICHELLE
Last Name:MCCABE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13303 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2508
Mailing Address - Country:US
Mailing Address - Phone:818-722-3230
Mailing Address - Fax:818-722-3230
Practice Address - Street 1:13303 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2508
Practice Address - Country:US
Practice Address - Phone:818-722-3230
Practice Address - Fax:818-722-3260
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 12930207P00000X
WV2257207P00000X
390200000X
OH34. 009349207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program