Provider Demographics
NPI:1356387740
Name:KUBITZ, EUGENE R (DPM)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:R
Last Name:KUBITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:2500 W STRUB RD
Practice Address - Street 2:SUITE 350
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5390
Practice Address - Country:US
Practice Address - Phone:419-627-1471
Practice Address - Fax:419-627-8941
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002906213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH480032147OtherMEDICARE RAILROAD
OH2021234Medicaid
OH480032147OtherMEDICARE RAILROAD
OHU66335Medicare UPIN
OH2021234Medicaid
OH0823915Medicare PIN