Todd Michael Kubon, BA, MAMS, CCA
Individual provider Active NPI Anaplastologist · Riverside, IL
NPI 1164804142 · NPPES record last updated Jun 25, 2015
Key facts
- NPI
- 1164804142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anaplastologist 229N00000X
- Practice address
- 317 Nuttall Rd
Riverside, IL 60546-1804 - Phone
- (312) 978-1073
- NPI assigned
- Jun 25, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor of Arts
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anaplastologist | 229N00000X | Yes |
Addresses
Primary practice location
317 Nuttall Rd
Riverside, IL 60546-1804
Mailing address
317 Nuttall Rd
Riverside, IL 60546-1804
Phone (312) 978-1073
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 229N00000X | Other | IL | WPC CODE |
Other providers in Riverside, IL
- Amy Lee Kienow Paychek
- Martin Peter Kornak
- Deborah J. Krause
- Diana Alexandra Kreppel
- Catherine J Kruse
- Gilbert Joseph Lafemina
- Lagom Counseling Services PLLC
- Dani Laliberte
- Scott Larson
- Carolyn Lawrence
All providers in Riverside, IL · Anaplastologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.