Provider Demographics
NPI:1871831024
Name:KUBBA, SAMAR D (DO)
Entity Type:Individual
Prefix:
First Name:SAMAR
Middle Name:D
Last Name:KUBBA
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 1:17000 HUBBARD DR 300
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4219
Mailing Address - Country:US
Mailing Address - Phone:313-271-3802
Mailing Address - Fax:313-271-2375
Practice Address - Street 1:1048 ALAMEDA BLVD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-6733
Practice Address - Country:US
Practice Address - Phone:614-270-9229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine