Provider Demographics
NPI:1609826288
Name:KARABALA, M THABET (MD)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:THABET
Last Name:KARABALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 N CENTER ST
Mailing Address - Street 2:STE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1326
Mailing Address - Country:US
Mailing Address - Phone:209-466-4222
Mailing Address - Fax:209-466-3306
Practice Address - Street 1:940 N CENTER ST
Practice Address - Street 2:STE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1326
Practice Address - Country:US
Practice Address - Phone:209-466-4222
Practice Address - Fax:209-466-3306
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA35322207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A353220Medicaid
CABL259ZMedicare PIN
CAA88328Medicare UPIN