Provider Demographics
NPI:1174557862
Name:SCHUBECK, DIANNE (MD)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:SCHUBECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 MEMPHIS AVE
Mailing Address - Street 2:METROHEALTH BROOKLYN MEDICAL GROUP
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-2231
Mailing Address - Country:US
Mailing Address - Phone:216-398-0100
Mailing Address - Fax:
Practice Address - Street 1:5208 MEMPHIS AVE
Practice Address - Street 2:METROHEALTH BROOKLYN MEDICAL GROUP
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144-2231
Practice Address - Country:US
Practice Address - Phone:216-398-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060365207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0928349Medicaid
OH0928349Medicaid
OHSC7271941Medicare ID - Type Unspecified