Organization
PRAIRIE SPINE AND PAIN INSTITUTE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD A KUBE II MD (OWNER)
(309) 691-7774
Entity
Organization
Contact information
Practice address
7620 N UNIVERSITY ST, STE. 104, PEORIA, IL 61614-1297
(309) 691-7774
Mailing address
PO BOX 5173, PEORIA, IL 61601-5173
(309) 691-6225
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
Other
Enumeration date
11/06/2008
Last updated
01/04/2022
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