Provider Demographics
NPI:1114954393
Name:HUBER, MICHAEL NEIL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NEIL
Last Name:HUBER
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 1:6090 ROYALTON RD
Mailing Address - Street 2:SUITE 335
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44133-5104
Mailing Address - Country:US
Mailing Address - Phone:330-237-8000
Mailing Address - Fax:877-921-2530
Practice Address - Street 1:6090 ROYALTON RD
Practice Address - Street 2:SUITE 335
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44133-5104
Practice Address - Country:US
Practice Address - Phone:330-237-8000
Practice Address - Fax:877-921-2530
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071679207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341926264034OtherCARESOURSE
OH000000141919OtherANTHEM
OH2009276Medicaid
OH341926264034OtherCARESOURSE
OHHU0833012Medicare ID - Type Unspecified
OH$$$$$$$$$005OtherMEDICAL MUTUAL