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Individual

DR. DOUGLAS CARL KUBEK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
21000 E 12 MILE RD, STE 111, SAINT CLAIR SHORES, MI 48081-1156
(586) 779-7610
(586) 779-1391
Mailing address
21000 E 12 MILE RD, STE 111, SAINT CLAIR SHORES, MI 48081-1156
(586) 263-7400
(586) 326-3161

Taxonomy

Speciality
Code
Description
License number
State
207YS0012X
Sleep Medicine (Otolaryngology) Physician
Primary
5101012806
MI
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
5101012806
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
040E061920
BLUE SHIELD
01
0455010215
BCBSM
MI
01
104200
GREAT LAKES HMO
MI
01
133060
CARE CHOICES
MI
01
14075
MCARE
MI
05
4535235
MI
Enumeration date
10/05/2006
Last updated
03/09/2021
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