Provider Demographics
NPI:1154363497
Name:LUBAK, KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:LUBAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W SONGER LN
Mailing Address - Street 2:
Mailing Address - City:VEEDERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47987-8547
Mailing Address - Country:US
Mailing Address - Phone:765-294-2486
Mailing Address - Fax:765-294-8026
Practice Address - Street 1:440 W SONGER LN
Practice Address - Street 2:
Practice Address - City:VEEDERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47987-8547
Practice Address - Country:US
Practice Address - Phone:765-294-2486
Practice Address - Fax:765-294-8026
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057635A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN941200WWMedicare ID - Type Unspecified