MEDICARE: LORI A. HUBACEK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1325-023	WI

General Provider Information

NPI Number	:	1831206358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI A. HUBACEK PA-C

Provider Business Mailing Address
First Line	:	2301 SUN VALLEY
Second Line	:
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2318
Country	:	US
Telephone Number	:	262-928-4043
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 SUN VALLEY
Second Line	:
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2318
Country	:	US
Telephone Number	:	262-928-4043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	09/05/2023

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