Basic Information
| Provider Information | |||||||||
| NPI: | 1780720219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUBAL | ||||||||
| FirstName: | AARUP | ||||||||
| MiddleName: | ANANT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1776 N PINE ISLAND RD | ||||||||
| Address2: | SUITE 214 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333225233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544529922 | ||||||||
| FaxNumber: | 9544529481 | ||||||||
| Practice Location | |||||||||
| Address1: | 1776 N PINE ISLAND RD | ||||||||
| Address2: | SUITE 214 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333225233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544529922 | ||||||||
| FaxNumber: | 9544529481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 51607 | MN | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | A113132 | CA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | ME 107766 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 51607 | 01 | MN | MN STATE MD LICENSE | OTHER | 1780720219 | 05 | MN | MEDICAID |