Provider Demographics
NPI:1801094313
Name:KADLEC, SABA J (MD)
Entity type:Individual
Prefix:
First Name:SABA
Middle Name:J
Last Name:KADLEC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SABA
Other - Middle Name:JUNE
Other - Last Name:ELDERKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6815 118TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-8420
Mailing Address - Country:US
Mailing Address - Phone:262-857-5600
Mailing Address - Fax:616-396-0085
Practice Address - Street 1:6815 118TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-8420
Practice Address - Country:US
Practice Address - Phone:262-857-5600
Practice Address - Fax:616-396-0085
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125602207W00000X
MI4301106903207W00000X
WI68428207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology