Provider Demographics
NPI:1649268194
Name:LUBERT, MARGARET A (DPM)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:LUBERT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 BALL CAMP PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-3334
Mailing Address - Country:US
Mailing Address - Phone:865-540-8188
Mailing Address - Fax:865-540-1006
Practice Address - Street 1:4313 BALL CAMP PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-3334
Practice Address - Country:US
Practice Address - Phone:865-540-8188
Practice Address - Fax:865-540-1006
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00427213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3352508Medicaid
171216OtherBLUE CROSS BLUE SHIELD
TN3352508Medicaid
171216OtherBLUE CROSS BLUE SHIELD