Provider Demographics
NPI:1932106622
Name:CABANSAG, VINCENTE D JR (MD)
Entity Type:Individual
Prefix:
First Name:VINCENTE
Middle Name:D
Last Name:CABANSAG
Suffix:JR
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 1:68930 VINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-8899
Mailing Address - Country:US
Mailing Address - Phone:269-651-9302
Mailing Address - Fax:269-651-4809
Practice Address - Street 1:68930 VINEWOOD AVE
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-8899
Practice Address - Country:US
Practice Address - Phone:269-651-9302
Practice Address - Fax:269-651-4809
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033706208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020750206OtherBCBS
MI1074410 TYPE 10Medicaid
MIOP12260Medicare ID - Type Unspecified
A76683Medicare UPIN