Provider Demographics
NPI:1396772653
Name:GUBITOSI-KLUG, ROSE A (MD)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:A
Last Name:GUBITOSI-KLUG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:216-286-6341
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0879722080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2659510OtherBCMH
OH2659510Medicaid
MI1396772653Medicaid
OH000000221226OtherUNISON
OH745910OtherBUCKEYE
OH000000526216OtherANTHEM
OH363591OtherWELLCARE
PA1022847300001Medicaid
OH7188773OtherAETNA
OH745910OtherBUCKEYE
MI1396772653Medicaid