Provider Demographics
NPI:1578501219
Name:PREBUS, SOL A (MD)
Entity Type:Individual
Prefix:DR
First Name:SOL
Middle Name:A
Last Name:PREBUS
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 1:10 STANDING ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:FORT YATES
Mailing Address - State:ND
Mailing Address - Zip Code:58538-8528
Mailing Address - Country:US
Mailing Address - Phone:701-854-8222
Mailing Address - Fax:
Practice Address - Street 1:10 STANDING ROCK AVE
Practice Address - Street 2:
Practice Address - City:FORT YATES
Practice Address - State:ND
Practice Address - Zip Code:58538-8528
Practice Address - Country:US
Practice Address - Phone:701-854-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37819208M00000X
TN35850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64061187Medicaid
KYK075151Medicare PIN