Provider Demographics
NPI:1023063922
Name:MENDIOLA, CARMELO CABALU (MD)
Entity type:Individual
Prefix:DR
First Name:CARMELO
Middle Name:CABALU
Last Name:MENDIOLA
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 1:2202 JORDAN ROAD SW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3688
Mailing Address - Country:US
Mailing Address - Phone:256-844-2825
Mailing Address - Fax:256-844-2834
Practice Address - Street 1:2202 JORDAN ROAD SW
Practice Address - Street 2:SUITE 500
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3688
Practice Address - Country:US
Practice Address - Phone:256-844-2825
Practice Address - Fax:256-844-2834
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00017265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051534925Medicaid
AL510-03718OtherBCBS
AL051557680Medicaid
AL515-34925OtherBCBS
AL541385603Medicaid
AL541385603Medicaid
ALF27601Medicare UPIN
AL051557680MENMedicare PIN
AL051557680Medicaid