Provider Demographics
NPI:1497766828
Name:KUERBITZ, CAROLYN HANISKO (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:HANISKO
Last Name:KUERBITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5853 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2021
Mailing Address - Country:US
Mailing Address - Phone:440-646-8426
Mailing Address - Fax:
Practice Address - Street 1:7 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3210
Practice Address - Country:US
Practice Address - Phone:440-357-6740
Practice Address - Fax:440-357-7906
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-068523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
EO5260Medicare UPIN