Provider Demographics
NPI:1609474790
Name:KABBAN, ELIAS (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:KABBAN
Suffix:
Gender:M
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W HURON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-1177
Mailing Address - Country:US
Mailing Address - Phone:989-269-2700
Mailing Address - Fax:989-269-2705
Practice Address - Street 1:128 W HURON AVE STE B
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1177
Practice Address - Country:US
Practice Address - Phone:989-269-2700
Practice Address - Fax:989-269-2705
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010004822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer