Provider Demographics
NPI:1215704994
Name:KABAT, TRISHA (PA)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:KABAT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:SRUBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3451 BARNARD RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2506
Mailing Address - Country:US
Mailing Address - Phone:616-295-3326
Mailing Address - Fax:
Practice Address - Street 1:600 N MAIN ST
Practice Address - Street 2:SET 220B
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734
Practice Address - Country:US
Practice Address - Phone:989-652-1422
Practice Address - Fax:989-583-1856
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011956363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant