Healthcare Provider Details

I. General information

NPI: 1972720365
Provider Name (Legal Business Name): CHARLES H. HUBER, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GREENHAVEN LN
GOSHEN KY
40026-8755
US

IV. Provider business mailing address

PO BOX 236
GOSHEN KY
40026-0236
US

V. Phone/Fax

Practice location:
  • Phone: 502-419-1109
  • Fax: 502-222-6116
Mailing address:
  • Phone: 502-419-1109
  • Fax: 502-222-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number151384
License Number StateKY

VIII. Authorized Official

Name: DR. CHARLES H HUBER
Title or Position: OWNER
Credential: MD
Phone: 502-419-1109