Healthcare Provider Details

I. General information

NPI: 1013574706
Provider Name (Legal Business Name): SPIROS KULUBIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

142 BATES TRL
WEST GREENWICH RI
02817-2554
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8450
  • Fax:
Mailing address:
  • Phone: 561-703-2957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101270694
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberLP05937
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: