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NPI Code Detail

MEDICARE: DR. RICHARD J LUBERA M.D.

MEDICARE: DR. RICHARD J LUBERA M.D.
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
1207R00000XInternal Medicine Physician4301024564MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1B44001OTHERMIRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
20501632OTHERMIBLUE CROSS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457327744
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD J LUBERA M.D.
Provider Business Mailing Address
First Line : 12296 E 12 MILE RD
Second Line :
City : WARREN
State : MI
Zip : 48093-3516
Country : US
Telephone Number : 586-751-5720
Fax Number : 586-751-2206
Provider Business Practice Location Address
First Line : 12296 E 12 MILE RD
Second Line :
City : WARREN
State : MI
Zip : 48093-3516
Country : US
Telephone Number : 586-751-5720
Fax Number : 586-751-2206
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 04/05/2011

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