MEDICARE: CAROLYN KUBITSCHEK

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	363LF0000X	Family Nurse Practitioner	041414394	IL

General Provider Information

NPI Number	:	1467004739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN KUBITSCHEK

Provider Business Mailing Address
First Line	:	515 W BRIAR PL APT 703
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 W BRIAR PL APT 703
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4628
Country	:	US
Telephone Number	:	828-230-5942
Fax Number	:

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

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	07/16/2019

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Directions to “ CAROLYN KUBITSCHEK ” Practice Location

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