MEDICARE: MICHAEL P DUBE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	01052038	IN
2	207RI0200X	Infectious Disease Physician	G55902	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134185887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL P DUBE M.D.

Provider Business Mailing Address
First Line	:	6255 W SUNSET BLVD FL 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7422
Country	:	US
Telephone Number	:	323-860-5200
Fax Number	:	323-467-7119

Provider Business Practice Location Address
First Line	:	1520 SAN PABLO ST STE 1000
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5312
Country	:	US
Telephone Number	:	323-442-5100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	05/08/2024

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