Provider Demographics
NPI:1093781676
Name:TYLER-KABARA, ELIZABETH CHRISTINE (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CHRISTINE
Last Name:TYLER-KABARA
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 MUELLER BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3079
Mailing Address - Country:US
Mailing Address - Phone:512-324-0907
Mailing Address - Fax:412-324-0642
Practice Address - Street 1:4900 MUELLER BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3079
Practice Address - Country:US
Practice Address - Phone:512-324-0907
Practice Address - Fax:412-324-0642
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068855L174400000X
TXS5284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101251901 0001Medicaid
PAI29404Medicare UPIN
PA090886FKCMedicare ID - Type Unspecified