Provider Demographics
NPI:1881645091
Name:KUBYCHECK, RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:KUBYCHECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N YORK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2950
Mailing Address - Country:US
Mailing Address - Phone:630-789-0400
Mailing Address - Fax:630-789-1504
Practice Address - Street 1:950 N YORK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2950
Practice Address - Country:US
Practice Address - Phone:630-789-0400
Practice Address - Fax:630-789-1504
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36056399207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL821050OtherHFMC GROUP MEDICARE PTAN
IL36056399Medicaid
IL821050OtherHFMC GROUP MEDICARE PTAN