Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 15518 | TX |
NPI | 1013066927 |
---|---|
Provider Name | Dr. Michael Kubelka |
First Address | Sugar Land, TX 77479-3012 |
Second Address | Sugar Land, TX 77479-3012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |