Individual
MICHAEL LEE KUBITZ
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
784 14TH AVE, LONGVIEW, WA 98632-2315
(360) 425-6111
(360) 636-1297
Mailing address
784 14TH AVE, LONGVIEW, WA 98632-2315
(360) 425-6111
(360) 636-1297
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
MD00032648
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
074773
—
OR
01
—
129610
WA LABOR & INDUSTRIES
WA
05
—
8173031
—
WA
Enumeration date
11/02/2005
Last updated
07/09/2007
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