Healthcare Provider Details

I. General information

NPI: 1497793343
Provider Name (Legal Business Name): CINDY A GUBBELS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 S 16TH ST
MILWAUKEE WI
53215-4526
US

IV. Provider business mailing address

2000 Q ST STE 500
LINCOLN NE
68503-3610
US

V. Phone/Fax

Practice location:
  • Phone: 414-527-8728
  • Fax:
Mailing address:
  • Phone: 402-421-0896
  • Fax: 402-421-0946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number38699-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number23845
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: