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NPI Code Detail

MEDICARE: DR. ANDREW WILLIAM MCKIBBEN MD

MEDICARE: DR. ANDREW WILLIAM MCKIBBEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0200XCritical Care Medicine (Internal Medicine) Physician36629MN
2207R00000XInternal Medicine Physician36629MN
3207RP1001XPulmonary Disease Physician36629MN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00098988OTHERMORAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427057447
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREW WILLIAM MCKIBBEN MD
Provider Business Mailing Address
First Line : FAIRVIEW RANGE MEDICAL CENTER
Second Line : 750 E 34TH ST
City : HIBBING
State : MN
Zip : 55746-2341
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : FAIRVIEW RANGE MEDICAL CENTER
Second Line : 750 E 34TH ST
City : HIBBING
State : MN
Zip : 55746-2341
Country : US
Telephone Number : 612-672-2258
Fax Number : 612-672-6041
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 02/23/2016

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