Healthcare Provider Details

I. General information

NPI: 1033883269
Provider Name (Legal Business Name): MARTIN S DUBRAVEC MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E MASON ST
CADILLAC MI
49601-1988
US

IV. Provider business mailing address

200 E MASON ST
CADILLAC MI
49601-1988
US

V. Phone/Fax

Practice location:
  • Phone: 231-779-4444
  • Fax:
Mailing address:
  • Phone: 231-779-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTIN DUBRAVEC
Title or Position: CEO PHYSICIAN HEALTH CARE PROVIDER
Credential:
Phone: 231-779-4444