Provider Demographics
NPI:1700066008
Name:KAB MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:KAB MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-323-3275
Mailing Address - Street 1:2998 S SARE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4330
Mailing Address - Country:US
Mailing Address - Phone:812-325-3275
Mailing Address - Fax:812-829-2596
Practice Address - Street 1:2998 S SARE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-4330
Practice Address - Country:US
Practice Address - Phone:812-325-3275
Practice Address - Fax:812-829-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057486A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780682062OtherNPI