Provider Demographics
NPI:1124065131
Name:HUBERT, STEVEN MATTHEW (PAC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MATTHEW
Last Name:HUBERT
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1781 HAVENSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-8737
Mailing Address - Country:US
Mailing Address - Phone:810-588-6130
Mailing Address - Fax:810-765-8169
Practice Address - Street 1:6071 W OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2624
Practice Address - Country:US
Practice Address - Phone:313-966-3300
Practice Address - Fax:810-765-8169
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-08-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1061022OtherNCCPA CERTIFICATE NUMBER