Provider Demographics
NPI:1639927627
Name:KUBAN, BARRY DEAN
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:DEAN
Last Name:KUBAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 E 96TH ST # ND1-11
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2917
Mailing Address - Country:US
Mailing Address - Phone:216-445-3204
Mailing Address - Fax:
Practice Address - Street 1:2111 E 96TH ST # ND1-11
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2917
Practice Address - Country:US
Practice Address - Phone:216-445-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch