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General NPI Number Information
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NPI Number | 1598983827
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Entity Type | Organization
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Legal Business Name | MICHAEL MCCUBBIN, MD, PC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 1108 WASHINGTON ST
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City | PELLA
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State | IA
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Zip | 50219-1508
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Country | US
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Telephone | 641-621-1487
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Fax | 641-621-1601
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Provider Business Mailing Address
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Address Line | 1108 WASHINGTON ST
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City | PELLA
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State | IA
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Zip | 50219-1508
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Country | US
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Telephone | 641-621-1487
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Fax | 641-621-1601
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MICHAEL M MCCUBBIN
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Credential | M.D.
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Telephone | 641-621-1487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | 21379
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License Number State | IA
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