Provider Demographics
NPI:1780682443
Name:ARBABI, KATHRYN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MARIE
Last Name:ARBABI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:MARIE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:585 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1548
Mailing Address - Country:US
Mailing Address - Phone:801-374-1801
Mailing Address - Fax:801-216-8357
Practice Address - Street 1:1212 MEDICAL PLAZA CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5653
Practice Address - Country:US
Practice Address - Phone:817-279-1776
Practice Address - Fax:817-279-7206
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9605207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00434ROtherMEDICARE GRP PTAN
TX171381001Medicaid
TX171381001Medicaid
TXTXB130943Medicare PIN
TX00434ROtherMEDICARE GRP PTAN