Provider Demographics
NPI:1962499046
Name:KUBICKI, KRZYSZTOF (MD)
Entity type:Individual
Prefix:
First Name:KRZYSZTOF
Middle Name:
Last Name:KUBICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:
Other - Last Name:KUBICKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2768
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-1968
Mailing Address - Country:US
Mailing Address - Phone:304-723-6040
Mailing Address - Fax:304-723-6039
Practice Address - Street 1:111 1ST ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:WV
Practice Address - Zip Code:26034-1001
Practice Address - Country:US
Practice Address - Phone:304-387-2761
Practice Address - Fax:304-387-3704
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17474207R00000X
OH35070327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0076313000Medicaid
OH0941413Medicaid
WV0076313000Medicaid
WVWV0450AMedicare PIN
OH0941413Medicaid