Provider Demographics
NPI:1225090731
Name:HUEBNER, CHARLES J (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:HUEBNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:STE 560
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-2150
Mailing Address - Fax:231-487-6562
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:STE 560
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-2150
Practice Address - Fax:231-487-6562
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2012-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301050683207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4086827 10Medicaid
MIE81434Medicare UPIN
MI4086827 10Medicaid