Provider Demographics
NPI:1295729168
Name:CABLE, KENNETH C (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:CABLE
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:PO BOX 13837
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-3837
Mailing Address - Country:US
Mailing Address - Phone:480-789-2039
Mailing Address - Fax:480-595-9862
Practice Address - Street 1:39810 N 105TH WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-3314
Practice Address - Country:US
Practice Address - Phone:480-789-2039
Practice Address - Fax:480-595-9862
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2007-11-28
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
AZ22364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF79309Medicare UPIN
AZZ111931Medicare PIN