Provider Demographics
NPI:1407242357
Name:KUBAT, RYAN CRAIG (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:CRAIG
Last Name:KUBAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:6068 DELP, MAIL STOP 1028
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:913-588-3891
Mailing Address - Fax:913-945-6916
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MEDICAL OFFICE BLDG, LEVEL 4
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-3974
Practice Address - Fax:913-588-6055
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
KS94-08748207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program