Provider Demographics
NPI:1932121803
Name:CABACUNGAN, ERWIN T (MD)
Entity Type:Individual
Prefix:MR
First Name:ERWIN
Middle Name:T
Last Name:CABACUNGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1324 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2161
Mailing Address - Country:US
Mailing Address - Phone:847-360-4264
Mailing Address - Fax:847-360-4261
Practice Address - Street 1:1324 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2161
Practice Address - Country:US
Practice Address - Phone:847-360-4264
Practice Address - Fax:847-360-4261
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI327152080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31862000Medicaid
WI945K 73-601Medicare ID - Type UnspecifiedMILWAUKEE COUNTY
WI31862000Medicaid