Provider Demographics
NPI:1962488965
Name:ABBO, KATHERINE M (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:M
Last Name:ABBO
Suffix:
Gender:F
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 8TH AVE
Mailing Address - Street 2:STE 3060
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5082
Mailing Address - Country:US
Mailing Address - Phone:262-656-3650
Mailing Address - Fax:262-656-3671
Practice Address - Street 1:6308 8TH AVE
Practice Address - Street 2:STE 3060
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5082
Practice Address - Country:US
Practice Address - Phone:262-656-3650
Practice Address - Fax:262-656-3671
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37204207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32177600Medicaid
WI1962488965Medicaid
WI32177600Medicaid
WI1962488965Medicaid
WI000432085Medicare PIN