Provider Demographics
NPI:1467749903
Name:MICHAEL BUBLIK MD PC
Entity Type:Organization
Organization Name:MICHAEL BUBLIK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUBLIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-488-3725
Mailing Address - Street 1:800 S CENTRAL AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4388
Mailing Address - Country:US
Mailing Address - Phone:818-649-1433
Mailing Address - Fax:818-649-1436
Practice Address - Street 1:800 S CENTRAL AVE STE 207
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4388
Practice Address - Country:US
Practice Address - Phone:818-649-1433
Practice Address - Fax:818-649-1436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112615207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty