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General NPI Number Information
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NPI Number | 1689605768
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Entity Type | Organization
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Legal Business Name | REBELSKY FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 210 4TH AVE
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City | GRINNELL
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State | IA
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Zip | 50112-1898
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Country | US
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Telephone | 641-236-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 210 4TH AVE
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City | GRINNELL
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State | IA
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Zip | 50112-1898
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Country | US
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Telephone | 641-236-2525
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MS. MICHELLE S REBELSKY
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Credential | M.D.
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Telephone | 641-236-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 32130
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License Number State | IA
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