Healthcare Provider Details

I. General information

NPI: 1770801953
Provider Name (Legal Business Name): CATHERINE D KUBIAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13145 66TH ST
LARGO FL
33773-1812
US

IV. Provider business mailing address

13145 66TH ST
LARGO FL
33773-1812
US

V. Phone/Fax

Practice location:
  • Phone: 727-530-0700
  • Fax:
Mailing address:
  • Phone: 727-530-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME116623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: