Provider Demographics
NPI:1770661845
Name:CARL J KUBEK DO PC
Entity Type:Organization
Organization Name:CARL J KUBEK DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUBEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-832-3271
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:300 N PATTERSON
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677
Mailing Address - Country:US
Mailing Address - Phone:231-832-3271
Mailing Address - Fax:
Practice Address - Street 1:300 N PATTERSON
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677
Practice Address - Country:US
Practice Address - Phone:231-832-3271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1901093Medicaid
MI1395800Medicaid
MI1870596Medicaid
MI1901093Medicaid
MI86700143313Medicare ID - Type Unspecified