Provider Demographics
NPI:1033420898
Name:KUERBITZ, THOMAS GREGORY II (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GREGORY
Last Name:KUERBITZ
Suffix:II
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:403 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3409
Mailing Address - Country:US
Mailing Address - Phone:850-767-3350
Mailing Address - Fax:850-767-3353
Practice Address - Street 1:300 N MILWAUKEE AVE STE D
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8563
Practice Address - Country:US
Practice Address - Phone:847-356-6634
Practice Address - Fax:847-356-7264
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2019-09-19
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Provider Licenses
StateLicense IDTaxonomies
WI2725363AM0700X
IL085003761363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical