MEDICARE: MAX BUBAR M.T.

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	173C00000X	Reflexologist

General Provider Information

NPI Number	:	1275870453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAX BUBAR M.T.

Provider Business Mailing Address
First Line	:	2103 SILVER BELL RD
Second Line	:	#307
City	:	EAGAN
State	:	MN
Zip	:	55122-1088
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2103 SILVER BELL RD
Second Line	:	#307
City	:	EAGAN
State	:	MN
Zip	:	55122-1088
Country	:	US
Telephone Number	:	651-276-3636
Fax Number	:

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

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	01/08/2013

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