1093781676 NPI number — DR. ELIZABETH CHRISTINE TYLER-KABARA MD PHD

Table of content: JANET L CHACE PHLEBOTOMIST (NPI 1760016604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093781676 NPI number — DR. ELIZABETH CHRISTINE TYLER-KABARA MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYLER-KABARA
Provider First Name:
ELIZABETH
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093781676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 LAUREL VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST LAKE HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78746-4406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-613-2072
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 N CAMPBELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85719-4330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-694-0111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD068855L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: S5284 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 78728 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101251901 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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