Provider Demographics
NPI:1093965014
Name:MICHAEL L.HUBNER, M.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL L.HUBNER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUBNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-712-8111
Mailing Address - Street 1:DEPT 78, P.O. BOX 21228
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-712-8111
Mailing Address - Fax:918-712-8222
Practice Address - Street 1:2000 S WHEELING AVE STE 1100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5646
Practice Address - Country:US
Practice Address - Phone:918-712-8111
Practice Address - Fax:918-712-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5219Medicare PIN