Provider Demographics
NPI:1588680888
Name:CABELLON, MICHELE COLLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:COLLEEN
Last Name:CABELLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8803 N MERIDIAN ST STE 175
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5310
Practice Address - Country:US
Practice Address - Phone:317-962-6875
Practice Address - Fax:317-962-0000
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002012292207RN0300X
IN01066926A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200950800Medicaid
MO209387109Medicaid
IN200950800Medicaid
IN264910BA9Medicare PIN
MO209387109Medicaid
927230183Medicare PIN
IN200950800Medicaid