Provider Demographics
NPI:1255345369
Name:KAHALLEY, STEPHEN ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:KAHALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 850489
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-0489
Mailing Address - Country:US
Mailing Address - Phone:251-342-3949
Mailing Address - Fax:251-631-3361
Practice Address - Street 1:610 PROVIDENCE PARK DR E
Practice Address - Street 2:BLDG 1 SUITE 102
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4622
Practice Address - Country:US
Practice Address - Phone:251-378-3900
Practice Address - Fax:251-378-3901
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00009877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51093042OtherBCBS OF AL
AL000093042OtherAL MEDICAID
AL0410743OtherUNITED HEALTHCARE
AL11217512OtherRAILROAD MEDICARE
AL000093042Medicare ID - Type Unspecified
ALC73547Medicare UPIN