Healthcare Provider Details

I. General information

NPI: 1295862811
Provider Name (Legal Business Name): STEVEN M LUBERA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9660 WICKER AVE
ST JOHN IN
46373-9487
US

IV. Provider business mailing address

1500 S LAKE PARK AVE MANAGED CARE DEPARTMENT
HOBART IN
46342-6638
US

V. Phone/Fax

Practice location:
  • Phone: 219-365-1166
  • Fax: 219-365-8852
Mailing address:
  • Phone: 219-947-6113
  • Fax: 219-947-6503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02003910A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036087048
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: