Provider Demographics
NPI:1518918093
Name:HUBBARD, TIFFANY A (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:A
Last Name:HUBBARD
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 1:201 N MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4216
Mailing Address - Country:US
Mailing Address - Phone:414-771-8228
Mailing Address - Fax:414-256-1909
Practice Address - Street 1:201 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4216
Practice Address - Country:US
Practice Address - Phone:414-771-8228
Practice Address - Fax:414-256-1909
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
005006261VOtherHUMANA
WI31946700Medicaid
WI31946700Medicaid
0010M73601Medicare ID - Type Unspecified