Susan Tubic

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4634 Issued in WI

Practice address

5151 S 108TH St
Hales Corners, WI 53130-1328

Phone

(414) 427-0900

Fax

(414) 427-1828

NPI assigned

Jan 3, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366509788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5151 S 108TH ST",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531301328",
            "telephone_number": "414-427-0900",
            "fax_number": "414-427-1828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5151 S 108TH ST",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531301328",
            "telephone_number": "414-427-0900",
            "fax_number": "414-427-1828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUBIC",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Tenlen, DPT
• The Color of Therapy LLC
• Thomas E. Raimann DDS
• David Francis Timmer, M.S.W.
• Jennifer Marie Tralongo, OTR
• Cassandra Ann Van Kleunen, D.D.S.
• Sandra M Vandomelen, SAC-IT
• Jordan Vandyck, DPT
• Village of Hales Corners
• Village of Hales Corners (Hales Corners Fire Dept)

• General Practice Dentistry in Hales Corners, WI
• Providers in Hales Corners, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.