Provider Demographics
NPI:1316065998
Name:KOUBA, ALLISON LUCILLE DOLLMAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:LUCILLE DOLLMAN
Last Name:KOUBA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:LUCILLE
Other - Last Name:DOLLMAN KOUBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7301 SECOR RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9737
Practice Address - Country:US
Practice Address - Phone:419-479-5795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.011680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316065998Medicaid
OH2983553Medicaid
OHP00947067OtherRR MEDICARE
OH2983553Medicaid
MI1316065998Medicaid