Provider Demographics
NPI:1588820674
Name:KABCHI JITANI, BADIH ANTONIO
Entity Type:Individual
Prefix:DR
First Name:BADIH
Middle Name:ANTONIO
Last Name:KABCHI JITANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 HOULTON LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3025
Mailing Address - Country:US
Mailing Address - Phone:252-295-8773
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN STE C840
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2594
Practice Address - Country:US
Practice Address - Phone:252-744-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT-0531207RC0200X
NC2014-02146207RC0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19011OtherBCBS NC
NC1588820674Medicaid
NC19011OtherBCBS NC