Provider Demographics
NPI:1720217292
Name:KABACK, MICHAEL MELVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MELVIN
Last Name:KABACK
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 1:4347 VISTA DE LA TIERRA
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-4106
Mailing Address - Country:US
Mailing Address - Phone:858-259-6801
Mailing Address - Fax:
Practice Address - Street 1:4347 VISTA DE LA TIERRA
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-4106
Practice Address - Country:US
Practice Address - Phone:858-259-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23170207SG0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics