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General NPI Number Information
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NPI Number | 1003903832
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Entity Type | Individual
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Provider Name | DOUGLAS CARL KUBEK D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 21000 E 12 MILE RD STE 111
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1156
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Country | US
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Telephone | 586-779-7610
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Fax | 586-779-1391
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Provider Business Mailing Address
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Address Line | 21000 E 12 MILE RD STE 111
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1156
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Country | US
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Telephone | 586-263-7400
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Fax | 586-326-3161
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
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License Number | 5101012806
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 5101012806
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License Number State | MI
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