Healthcare Provider Details

I. General information

NPI: 1801387279
Provider Name (Legal Business Name): YOSEF YITZCHOK HUBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22255 GREENFIELD RD STE 280
SOUTHFIELD MI
48075-3712
US

IV. Provider business mailing address

22255 GREENFIELD RD STE 280
SOUTHFIELD MI
48075-3712
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-4990
  • Fax: 248-849-4991
Mailing address:
  • Phone: 248-849-4990
  • Fax: 248-849-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301115096
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301504575
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: