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General NPI Number Information
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NPI Number | 1801329412
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Entity Type | Individual
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Provider Name | KELLY M KUBIAK D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 784 MEDINA RD STE 107
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City | MEDINA
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State | OH
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Zip | 44256-9634
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Country | US
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Telephone | 330-591-9635
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Fax | 330-591-4150
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Provider Business Mailing Address
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Address Line | 365 RIFFEL RD STE A
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City | WOOSTER
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State | OH
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Zip | 44691-8592
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Country | US
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Telephone | 440-856-5958
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Fax |
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 36.003911
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License Number State | OH
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