Individual
POLLYANNA KABARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
LAKESIDE PEDIATRICS, 8600 75TH STREET, KENOSHA, WI 53142
(262) 652-9430
(262) 652-9433
Mailing address
LAKESIDE PEDIATRICS, 8600 75TH STREET, KENOSHA, WI 53142
(262) 652-9430
(262) 652-9433
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1389
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008006261X
HUMANA
—
05
—
1134173479
—
WI
Enumeration date
05/20/2006
Last updated
01/11/2022
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