MEDICARE: MICHAL MAYBELLO ABUTBUL MHR

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1619075967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAL MAYBELLO ABUTBUL MHR

Provider Business Mailing Address
First Line	:	5743 E 30TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-6415
Country	:	US
Telephone Number	:	918-346-1918
Fax Number	:

Provider Business Practice Location Address
First Line	:	3015 E SKELLY DR
Second Line	:	SUITE 390
City	:	TULSA
State	:	OK
Zip	:	74105-6317
Country	:	US
Telephone Number	:	918-665-0208
Fax Number	:	918-665-0216

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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