Provider Demographics
NPI:1275870453
Name:BUBAR, MAX (MT)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:BUBAR
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 SILVER BELL RD
Mailing Address - Street 2:#307
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1088
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2103 SILVER BELL RD
Practice Address - Street 2:#307
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1088
Practice Address - Country:US
Practice Address - Phone:651-276-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist