MEDICARE: GENE MICHAEL KUBACKI DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	16884	MS
2	207Q00000X	Family Medicine Physician	036098945	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275680258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENE MICHAEL KUBACKI DO

Provider Business Mailing Address
First Line	:	2932 W LUDWIG RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1328
Country	:	US
Telephone Number	:	260-755-1304
Fax Number	:	260-755-1306

Provider Business Practice Location Address
First Line	:	1029 EAST 130TH STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628
Country	:	US
Telephone Number	:	773-995-6300
Fax Number	:	601-376-2114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	12/16/2019

Similar Medicare Providers

1780529677 — MR. SHERROD BROWN LCSW
Practice Location Address:

10536 S VERNON AVE
CHICAGO, IL
60628-2952

Practice Phone: 262-864-3804
Practice Fax:

1669079018 — ISMAIL ADEBAYO OYEBODE APN
Practice Location Address:

11000 S HALSTED ST
CHICAGO, IL
60628-3909

Practice Phone: 773-517-3183
Practice Fax:

1104657584 — MRS. KRYSTAL M FOWLER LCPC; LPC
Practice Location Address:

259 E 115TH ST
CHICAGO, IL
60628-5014

Practice Phone: 773-253-8385
Practice Fax:

1831664127 — DOLORITA HAKOMA ONGURU MSN, AGACNP-BC
Practice Location Address:

9500 S S. DORCHESTER , SUITE 100
CHICAGO, IL
60628

Practice Phone: 773-667-0768
Practice Fax: 773-667-5529

1508709148 — THE GOOD SAMARITAN HOUSE
Practice Location Address:

29 W 124TH ST FL 2
CHICAGO, IL
60628-7301

Practice Phone: 773-458-8539
Practice Fax:

1598757726 — CHICAGO DEPARTMENT OF PUBLIC HEALTH
Practice Location Address:

ROSELAND MENTAL HEALTH CENTER , 28 E 112TH PLACE
CHICAGO, IL
60628

Practice Phone: 312-747-7320
Practice Fax: 312-747-9143

1992797138 — CITY OF CHICAGO
Practice Location Address:

ROSELAND M.H.C. , 200 E 115TH STREET
CHICAGO, IL
60628

Practice Phone: 312-747-1090
Practice Fax: 312-744-1904

Directions to “ GENE MICHAEL KUBACKI DO” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.