MEDICARE: MICHAEL MCCUBBIN, MD, PC

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	2080P0201X	Pediatric Allergy/Immunology Physician	21379	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35603	OTHER	IA	WELLMARK
2	35603	OTHER		WELLMARK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598983827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL MCCUBBIN, MD, PC

Provider Business Mailing Address
First Line	:	1108 WASHINGTON ST
Second Line	:
City	:	PELLA
State	:	IA
Zip	:	50219-1508
Country	:	US
Telephone Number	:	641-621-1487
Fax Number	:	641-621-1601

Provider Business Practice Location Address
First Line	:	1108 WASHINGTON ST
Second Line	:
City	:	PELLA
State	:	IA
Zip	:	50219-1508
Country	:	US
Telephone Number	:	641-621-1487
Fax Number	:	641-621-1601

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	MICHAEL M MCCUBBIN
Credential	:	M.D.
Telephone Number	:	641-621-1487

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	11/10/2010

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