Provider Demographics
NPI:1659354140
Name:HUBKA, TERESA A (DO)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:A
Last Name:HUBKA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 578220
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7303
Mailing Address - Country:US
Mailing Address - Phone:773-549-8900
Mailing Address - Fax:773-549-8511
Practice Address - Street 1:3152 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3117
Practice Address - Country:US
Practice Address - Phone:773-549-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086740207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621679OtherBCBS OF IL
IL036086740Medicaid
IL036086740Medicaid
ILF 86195Medicare UPIN