MEDICARE: MICHAEL ERICH KUBALA M.D.

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Y00000X	Otolaryngology Physician	S0487	TX

General Provider Information

NPI Number	:	1598184418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ERICH KUBALA M.D.

Provider Business Mailing Address
First Line	:	6300 W PARKER RD STE G24
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-8105
Country	:	US
Telephone Number	:	972-378-0633
Fax Number	:	972-378-0656

Provider Business Practice Location Address
First Line	:	6300 W PARKER RD STE G24
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-8105
Country	:	US
Telephone Number	:	972-378-0633
Fax Number	:	972-378-0656

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	05/17/2021

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