Provider Demographics
NPI:1801874789
Name:CABAN, MIDALIE JOHANE (MD)
Entity type:Individual
Prefix:MRS
First Name:MIDALIE
Middle Name:JOHANE
Last Name:CABAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:RODRIGUEZ OLMO CALLE L #16
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-878-5583
Mailing Address - Fax:787-854-0352
Practice Address - Street 1:PARQUE INDUSTRIAL DCH
Practice Address - Street 2:KM 48 6 CARR #2
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-6564
Practice Address - Fax:787-854-0352
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11451208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H80166Medicare UPIN
0021218Medicare ID - Type Unspecified