NPIMap

Individual provider Active NPI

Douglas Carl Kubek, D.O.

  • Sleep Medicine (Otolaryngology) Physician
  • Saint Clair Shores, MI
National Provider Identifier
1003903832
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Otolaryngology) PhysicianTaxonomy code 207YS0012X
License
5101012806 Issued in MI
Practice address
21000 E 12 Mile Rd
Ste 111
Saint Clair Shores, MI 48081-1156
Phone
(586) 779-7610
Fax
(586) 779-1391
NPI assigned
Oct 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Otolaryngology) Physician 207YS0012X 5101012806 MI Primary
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X 5101012806 MI

Addresses

Primary practice location

21000 E 12 Mile Rd
Ste 111
Saint Clair Shores, MI 48081-1156

Mailing address

21000 E 12 Mile Rd
Ste 111
Saint Clair Shores, MI 48081-1156
Phone (586) 263-7400

Other identifiers 6

IdentifierTypeStateIssuer
0455010215OtherMIBCBSM
14075OtherMIMCARE
040E061920OtherBLUE SHIELD
133060OtherMICARE CHOICES
104200OtherMIGREAT LAKES HMO
4535235MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dkubek57914@direct.hfhs.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080521000862 MI Practitioner - OtolaryngologyPractitioner - Plastic and Reconstructive Surgery 9931278579 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
OtolaryngologyAlso: Plastic and Reconstructive Surgery
Education
Midwestern University, Chicago College of Osteopathic Med, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

17900 23 Mile Rd
Macomb, MI 48044-1161
Phone (586) 286-6565

21000 E 12 Mile Rd
Suite 111
Saint Clair Shores, MI 48081-1156
Phone (586) 779-7610

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital CurrentSince Feb 1, 2012 Accepting new patients
Henry Ford Health St. John Hospital Otolaryngology CurrentSince Feb 1, 2012 Accepting new patients
Lakeshore Ear Nose and Throat Center PC Otolaryngology CurrentSince Nov 26, 2018 Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients
Henry Ford Semi Medical Group CurrentSince Dec 9, 2012 Accepting new patients
Lakeshore Ear Nose and Throat Center PC Otolaryngology Current Accepting new patients
Henry Ford Semi Medical Group Current Accepting new patients
Julie N Sherbin Sher DO PLLC Past Accepting new patients
St. John Hospital Past Accepting new patients
Sherbin Business Systems Past Accepting new patients

Locations

43750 Garfield Rd
Ste 101
Clinton Twp, MI 48038
Phone (586) 263-7400

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2300

22201 Moross Rd
Ste 252
Grosse Pointe, MI 48236
Phone (313) 343-4411

17770 Mack Ave
Grosse Pointe Shores, MI 48230
Phone (313) 882-1731

17900 23 Mile Rd
Ste 203
Macomb, MI 48044
Phone (586) 263-7400

17900 23 Mile Rd
Ste 205
Macomb, MI 48044
Phone (313) 885-6367

21000 E 12 Mile Rd
Ste 111
St Clr Shores, MI 48081
Phone (586) 779-7610

13355 E 10 Mile Rd
Ste 210
Warren, MI 48089
Phone (586) 758-5051

Interoperability endpoints

  • Direct secure messaging: douglas.kubek.1@17789.direct.athenahealth.com

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1003903832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21000 E 12 MILE RD",
            "address_2": "STE 111",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811156",
            "telephone_number": "586-263-7400",
            "fax_number": "586-326-3161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21000 E 12 MILE RD",
            "address_2": "STE 111",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811156",
            "telephone_number": "586-779-7610",
            "fax_number": "586-779-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBEK",
        "first_name": "DOUGLAS",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YS0012X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Sleep Medicine",
            "state": "MI",
            "license": "5101012806",
            "primary": true
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "MI",
            "license": "5101012806",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0455010215",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE",
            "identifier": "14075",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "040E061920",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "133060",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES HMO",
            "identifier": "104200",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4535235",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dkubek57914@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "15855 19 Mile Rd",
            "city": "Clinton Township",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480383504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.