Basic Information
| Provider Information | |||||||||
| NPI: | 1255345369 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAHALLEY | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 850489 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366850489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513423949 | ||||||||
| FaxNumber: | 2516313361 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 PROVIDENCE PARK DR E | ||||||||
| Address2: | BLDG 1 SUITE 102 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366954622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513783900 | ||||||||
| FaxNumber: | 2513783901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 06/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 00009877 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 51093042 | 01 | AL | BCBS OF AL | OTHER | 000093042 | 01 | AL | AL MEDICAID | OTHER | 0410743 | 01 | AL | UNITED HEALTHCARE | OTHER | 11217512 | 01 | AL | RAILROAD MEDICARE | OTHER |