Provider Demographics
NPI:1659677656
Name:CABANILLA, BELISARIO R (MD)
Entity Type:Individual
Prefix:
First Name:BELISARIO
Middle Name:R
Last Name:CABANILLA
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 1:800 N LINDBERGH BLVD # LC1F
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63167-0001
Mailing Address - Country:US
Mailing Address - Phone:314-604-8629
Mailing Address - Fax:314-694-5670
Practice Address - Street 1:800 N LINDBERGH BLVD # LC1F
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63167-0001
Practice Address - Country:US
Practice Address - Phone:314-604-8629
Practice Address - Fax:314-694-5670
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010223342083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine