Provider Demographics
NPI:1407020761
Name:LUBERT, ADAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:M
Last Name:LUBERT
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:CARDIOLOGY
Mailing Address - Street 2:3333 BURNET AVE. - ML 2003
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229
Mailing Address - Country:US
Mailing Address - Phone:513-636-4432
Mailing Address - Fax:513-636-3952
Practice Address - Street 1:CARDIOLOGY
Practice Address - Street 2:3333 BURNET AVE. - ML 2003
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-4432
Practice Address - Fax:513-636-3952
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0984082080P0202X, 207RA0002X, 207RC0000X
OH35-098408208000000X
MI4301102262208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Yes207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100204670Medicaid
OH0065897Medicaid
IN201086450Medicaid
OH0065897Medicaid