Provider Demographics
NPI:1336187335
Name:CABE, MARIA THERESA A (MD)
Entity Type:Individual
Prefix:
First Name:MARIA THERESA
Middle Name:A
Last Name:CABE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-478-5180
Mailing Address - Fax:260-483-6375
Practice Address - Street 1:3534 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809-1361
Practice Address - Country:US
Practice Address - Phone:260-478-5180
Practice Address - Fax:260-483-6375
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044196A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000494081OtherBLUE CROSS BLUE SHIELD
IN100376370Medicaid
000000494081OtherBLUE CROSS BLUE SHIELD
INM400048114Medicare PIN
IN925500JJMedicare PIN
IN925510CCMedicare PIN
IN925550FMedicare PIN
000000494081OtherBLUE CROSS BLUE SHIELD
IN150640SSSMedicare PIN
IN925530JMedicare PIN
INF65525Medicare UPIN
IN100376370Medicaid