Provider Demographics
NPI:1922270933
Name:KUBEK, MICHAEL IV (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KUBEK
Suffix:IV
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-4001
Mailing Address - Country:US
Mailing Address - Phone:734-458-3430
Mailing Address - Fax:
Practice Address - Street 1:19805 CRYSTAL LAKE DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2522
Practice Address - Country:US
Practice Address - Phone:248-449-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016047207P00000X
IN02003348A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine