Healthcare Provider Details

I. General information

NPI: 1992236418
Provider Name (Legal Business Name): JUDITH M KABAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH CHATTO

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E CHESTNUT ST # 4B
LOUISVILLE KY
40202-1713
US

IV. Provider business mailing address

PO BOX 776879
CHICAGO IL
60677-6879
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-3600
  • Fax: 502-588-9536
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number53621
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.155705
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number53621
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: