Provider Demographics
NPI:1598184418
Name:KUBALA, MICHAEL ERICH (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ERICH
Last Name:KUBALA
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 1:6300 W PARKER RD STE G24
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8105
Mailing Address - Country:US
Mailing Address - Phone:972-378-0633
Mailing Address - Fax:972-378-0656
Practice Address - Street 1:6300 W PARKER RD STE G24
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8105
Practice Address - Country:US
Practice Address - Phone:972-378-0633
Practice Address - Fax:972-378-0656
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS0487207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program