Provider Demographics
NPI:1104195635
Name:MICHAEL TUBIANOSA MD INC
Entity Type:Organization
Organization Name:MICHAEL TUBIANOSA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TUBIANOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-277-9645
Mailing Address - Street 1:PO BOX 235893
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-3516
Mailing Address - Country:US
Mailing Address - Phone:808-277-9645
Mailing Address - Fax:
Practice Address - Street 1:128 LEHUA ST
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2036
Practice Address - Country:US
Practice Address - Phone:808-621-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD15564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty