Brian Kubacak, MD
Individual provider Active NPI Child & Adolescent Psychiatry Physician · Little Rock, AR
NPI 1629168299 · NPPES record last updated Nov 30, 2011
Key facts
- NPI
- 1629168299
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Child & Adolescent Psychiatry Physician 2084P0804X
- License
- E-2191 (AR)
- Practice address
- 4301 W Markham St # 783
Little Rock, AR 72205-7101 - Phone
- (501) 686-8000
- NPI assigned
- Oct 13, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-2191 | AR | MD | Child & Adolescent Psychiatry Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | E-2191 | AR | Yes |
Addresses
Primary practice location
4301 W Markham St # 783
Little Rock, AR 72205-7101
Mailing address
4301 W Markham St # 783
Little Rock, AR 72205-7101
Phone (501) 686-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 145138001 | Medicaid | AR |
Other providers in Little Rock, AR
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- KSJR Healthcare, LLC
- C David Kuchinski Jr.
- Candice Baker Kuddes
- Teddi Kueter
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- Sarah Kuhn
All providers in Little Rock, AR · Child & Adolescent Psychiatry Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2011. 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.