Basic Information
| Provider Information | |||||||||
| NPI: | 1619950730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUBITSCHEK | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | RAPHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 VANDERBILT PARK DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288031700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282580397 | ||||||||
| FaxNumber: | 8282583390 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 VANDERBILT PARK DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288031700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282580397 | ||||||||
| FaxNumber: | 8282583390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 09/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 29612 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 50443 | 01 | NC | BLUE CROSS NUMBER | OTHER | 208013A | 01 | NC | MEDICARE ECP | OTHER | 7950443 | 05 | NC | MEDICAID |