Provider Demographics
NPI:1336134899
Name:ZUBA, MICHELLE L (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:ZUBA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 UNION AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2134
Mailing Address - Country:US
Mailing Address - Phone:724-226-7415
Mailing Address - Fax:724-226-7109
Practice Address - Street 1:1629 UNION AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2134
Practice Address - Country:US
Practice Address - Phone:724-226-7415
Practice Address - Fax:724-226-7109
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013900208600000X
PAOS014938208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4449997Medicaid
MIN81820002Medicare ID - Type Unspecified
MI4449997Medicaid