Provider Demographics
NPI:1720053010
Name:KABELL, GAEL GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:GAEL
Middle Name:GLENN
Last Name:KABELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1722 SHAFFER ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1633
Mailing Address - Country:US
Mailing Address - Phone:269-381-3963
Mailing Address - Fax:269-381-2809
Practice Address - Street 1:1722 SHAFFER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1633
Practice Address - Country:US
Practice Address - Phone:269-381-3963
Practice Address - Fax:269-381-2809
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301052450207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4524732Medicaid
MIC65611Medicare UPIN