Individual
GENE MICHAEL KUBACKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1029 EAST 130TH STREET, CHICAGO, IL 60628
(773) 995-6300
(601) 376-2114
Mailing address
2932 W LUDWIG RD, FORT WAYNE, IN 46818-1328
(260) 755-1304
(260) 755-1306
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036098945
IL
207Q00000X
Family Medicine Physician
16884
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036098945
—
IL
05
—
04009076
—
MS
Enumeration date
01/04/2007
Last updated
12/16/2019
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