Provider Demographics
NPI:1174560353
Name:KABATAY-LEE HO, MARIA RHODORA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:RHODORA
Last Name:KABATAY-LEE HO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RHODORA
Other - Middle Name:
Other - Last Name:KABATAY-LEE HO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 505673
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5673
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 S 13TH ST
Practice Address - Street 2:SUITE I
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4936
Practice Address - Country:US
Practice Address - Phone:309-346-1102
Practice Address - Fax:309-347-2885
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024015912207Q00000X
IL036107438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107438Medicaid
IL09015685OtherBLUE CROSS BLUE SHIELD
ILP000329021OtherRAIL ROAD MEDICARE
ILP000329021OtherRAIL ROAD MEDICARE
IL036107438Medicaid