Healthcare Provider Details

I. General information

NPI: 1154385623
Provider Name (Legal Business Name): VINCENT J DUBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 E ELM ST
CARSON CITY MI
48811
US

IV. Provider business mailing address

406 E ELM ST PO BOX 879
CARSON CITY MI
48811
US

V. Phone/Fax

Practice location:
  • Phone: 989-584-3971
  • Fax:
Mailing address:
  • Phone: 989-584-3971
  • Fax: 989-584-3729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301010590
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: