Provider Demographics
NPI:1629334420
Name:E.S.CABAL JR MD INC
Entity Type:Organization
Organization Name:E.S.CABAL JR MD INC
Other - Org Name:E.S.CABAL,JR.,INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OB-GYN
Authorized Official - Prefix:DR
Authorized Official - First Name:EUSTAQUIO
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:CABAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:440-835-6205
Mailing Address - Street 1:29099 HEALTH CAMPUS DR BLDG 3
Mailing Address - Street 2:SUITE280
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5200
Mailing Address - Country:US
Mailing Address - Phone:440-835-6205
Mailing Address - Fax:
Practice Address - Street 1:29099 HEALTH CAMPUS DR BLDG 3
Practice Address - Street 2:SUITE280
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5200
Practice Address - Country:US
Practice Address - Phone:440-835-6205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-034397207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0183331Medicaid