Provider Demographics
NPI:1326092693
Name:TREBIAN, KATHLEEN MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARY
Last Name:TREBIAN
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2524 E WEBSTER PL STE 303
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4268
Mailing Address - Country:US
Mailing Address - Phone:414-271-1116
Mailing Address - Fax:414-271-1114
Practice Address - Street 1:2524 E WEBSTER PL STE 303
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4268
Practice Address - Country:US
Practice Address - Phone:414-271-1116
Practice Address - Fax:414-271-1114
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI33771-020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32455900Medicaid
WI32455900Medicaid