Provider Demographics
NPI:1932996048
Name:KUBELKA, NICHOLAS KNESEK (PH D, D O)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:KNESEK
Last Name:KUBELKA
Suffix:
Gender:M
Credentials:PH D, D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 PARKWOOD BLVD APT 302
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6526
Mailing Address - Country:US
Mailing Address - Phone:281-414-8558
Mailing Address - Fax:281-414-8558
Practice Address - Street 1:3401 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6332
Practice Address - Country:US
Practice Address - Phone:580-355-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program