Healthcare Provider Details

I. General information

NPI: 1760619092
Provider Name (Legal Business Name): MARTIN KUBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 HARRISON PKWY SUITE 200
SUNRISE FL
33323-2896
US

IV. Provider business mailing address

1613 HARRISON PKWY SUITE 200
SUNRISE FL
33323-2896
US

V. Phone/Fax

Practice location:
  • Phone: 800-437-2672
  • Fax:
Mailing address:
  • Phone: 800-437-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME114254
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: