Healthcare Provider Details

I. General information

NPI: 1750910147
Provider Name (Legal Business Name): MICHAEL PRIBULA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 E LINCOLNWAY
MINERVA OH
44657-1216
US

IV. Provider business mailing address

1028 E LINCOLNWAY
MINERVA OH
44657-1216
US

V. Phone/Fax

Practice location:
  • Phone: 330-868-6044
  • Fax:
Mailing address:
  • Phone: 330-868-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00000000000000000000
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: