MEDICARE: JAMES MICHAEL REBIK D.O.

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	207Y00000X	Otolaryngology Physician	3595	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300522256	OTHER	OK	OK MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1346246584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES MICHAEL REBIK D.O.

Provider Business Mailing Address
First Line	:	421 E. HARTFORD AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601
Country	:	US
Telephone Number	:	580-718-4502
Fax Number	:	580-765-2123

Provider Business Practice Location Address
First Line	:	421 E. HARTFORD AVE.
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601
Country	:	US
Telephone Number	:	580-718-4502
Fax Number	:	580-765-2123

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/26/2013

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