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General NPI Number Information
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NPI Number | 1821037532
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Entity Type | Individual
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Provider Name | ROD STEPHEN KUBLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 1919 LAKE AVE SUITE 104
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City | PLYMOUTH
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State | IN
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Zip | 46563-7830
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Country | US
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Telephone | 574-941-2929
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Fax | 574-941-3008
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Provider Business Mailing Address
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Address Line | 707 E CEDAR ST STE 200
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City | SOUTH BEND
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State | IN
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Zip | 46617-2057
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Country | US
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Telephone | 574-335-8700
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Fax | 574-335-0760
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01035442
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License Number State | IN
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