Provider Demographics
NPI:1891760484
Name:KUBAREK, SEEMA MITAL (MD)
Entity Type:Individual
Prefix:DR
First Name:SEEMA
Middle Name:MITAL
Last Name:KUBAREK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SEEMA
Other - Middle Name:
Other - Last Name:MITAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6352 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2241
Mailing Address - Country:US
Mailing Address - Phone:253-968-3066
Mailing Address - Fax:253-968-0384
Practice Address - Street 1:6352 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2241
Practice Address - Country:US
Practice Address - Phone:253-968-3066
Practice Address - Fax:253-968-0384
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81370208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260129000Medicaid
FL260129000Medicaid