Provider Demographics
NPI:1124151410
Name:JOHN G KUBLIN MD PC
Entity type:Organization
Organization Name:JOHN G KUBLIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KUBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-226-2531
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-226-2531
Mailing Address - Fax:906-226-7555
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-226-2531
Practice Address - Fax:906-226-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJK024282207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2018470Medicaid
MI1805249991OtherBLUE CROSS
MIA77599Medicare UPIN
MI0P43000Medicare ID - Type Unspecified
MI2018470Medicaid