Provider Demographics
NPI:1548238454
Name:SABIN, KELLI RUTH (MD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:RUTH
Last Name:SABIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3766
Mailing Address - Country:US
Mailing Address - Phone:330-836-8471
Mailing Address - Fax:
Practice Address - Street 1:130 N MILLER RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3766
Practice Address - Country:US
Practice Address - Phone:330-836-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350705645S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0276133Medicaid
OH729922OtherBUCKEYE COMMUNITY
OH93272OtherQUALCHOICE INS
OH426OtherSUMMACARE INS
OHQ018591OtherHOMETOWN INS
OH000000312589OtherANTHEM INSURANCE
OH426OtherSUMMACARE INS
OHSA0821383Medicare ID - Type Unspecified