Provider Demographics
NPI:1003825753
Name:KUBIAK, ERIK NOBLE (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:NOBLE
Last Name:KUBIAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2000
Mailing Address - Fax:
Practice Address - Street 1:2231 WEST CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-383-2663
Practice Address - Fax:702-383-2682
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6597691-1205207X00000X
NV16775207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8460222Medicaid
WAI60438Medicare UPIN
NVV115310Medicare PIN
WA8861573Medicare ID - Type UnspecifiedUW PHYSICIANS