Healthcare Provider Details

I. General information

NPI: 1508408139
Provider Name (Legal Business Name): MR. MICHAEL J. KOBAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 MANOR DR STE 10
EBENSBURG PA
15931-4917
US

IV. Provider business mailing address

706 N 10TH ST
BELLWOOD PA
16617-1020
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-6060
  • Fax: 814-472-1293
Mailing address:
  • Phone: 814-254-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: