Provider Demographics
NPI:1710462247
Name:KUBE, MYAH PATRICIA
Entity Type:Individual
Prefix:
First Name:MYAH
Middle Name:PATRICIA
Last Name:KUBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10084 LUDLOW AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1523
Mailing Address - Country:US
Mailing Address - Phone:248-885-6627
Mailing Address - Fax:
Practice Address - Street 1:10084 LUDLOW AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1523
Practice Address - Country:US
Practice Address - Phone:248-885-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician