Provider Demographics
NPI:1902429848
Name:GABORKO, KATE
Entity Type:Individual
Prefix:MRS
First Name:KATE
Middle Name:
Last Name:GABORKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 WALTER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2109
Mailing Address - Country:US
Mailing Address - Phone:216-280-0730
Mailing Address - Fax:
Practice Address - Street 1:3830 WALTER RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2109
Practice Address - Country:US
Practice Address - Phone:216-280-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2021-01-11
Deactivation Date:2020-05-28
Deactivation Code:
Reactivation Date:2021-01-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1831527Medicaid