Provider Demographics
NPI:1639373095
Name:SRIUBIENE, INGA (MD)
Entity Type:Individual
Prefix:DR
First Name:INGA
Middle Name:
Last Name:SRIUBIENE
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 1:3950 HOLLYWOOD RD
Mailing Address - Street 2:STE 250
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9151
Mailing Address - Country:US
Mailing Address - Phone:269-408-1115
Mailing Address - Fax:269-408-1166
Practice Address - Street 1:3950 HOLLYWOOD RD STE 250
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9151
Practice Address - Country:US
Practice Address - Phone:269-408-1115
Practice Address - Fax:269-408-1166
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086073207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0110024OtherBCBS PIN
MI1639373095Medicaid
MIMI2051001Medicare PIN