Healthcare Provider Details

I. General information

NPI: 1194071035
Provider Name (Legal Business Name): MICHAEL HAYDEN BUBIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 FANNIN ST # 1.150
HOUSTON TX
77030-1501
US

IV. Provider business mailing address

6431 FANNIN ST # 1.150
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-6500
  • Fax: 713-500-6497
Mailing address:
  • Phone: 713-500-6500
  • Fax: 713-500-6497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP5781
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: