MEDICARE: MITCHELL HUEBNER, 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
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1801436753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL HUEBNER, MD

Provider Business Mailing Address
First Line	:	5477 GLEN LAKES DR STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4381
Country	:	US
Telephone Number	:	214-361-2277
Fax Number	:	214-361-2273

Provider Business Practice Location Address
First Line	:	5477 GLEN LAKES DR STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4381
Country	:	US
Telephone Number	:	214-361-2277
Fax Number	:	214-361-2273

Authorized Official
Title or Position	:	OWNER
Name	:	MITCHELL LEE HUEBNER
Credential	:	MD
Telephone Number	:	214-361-2277

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	03/17/2020

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