Provider Demographics
NPI:1215022934
Name:LABUWI, CHARLES MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MICHAEL
Last Name:LABUWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 MOUNTAIN VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1134
Mailing Address - Country:US
Mailing Address - Phone:541-883-3591
Mailing Address - Fax:541-883-2886
Practice Address - Street 1:2310 MOUNTAIN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1134
Practice Address - Country:US
Practice Address - Phone:541-883-3591
Practice Address - Fax:541-883-2886
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005082Medicaid
CAXPY183282OtherMEDICAL OF CALIFORNIA
OOWCHVNBMedicare ID - Type Unspecified
OR005082Medicaid