Provider Demographics
NPI:1598983827
Name:MICHAEL MCCUBBIN, MD, PC
Entity Type:Organization
Organization Name:MICHAEL MCCUBBIN, MD, PC
Other - Org Name:ALLERGY, LUNG AND SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCUBBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-621-1487
Mailing Address - Street 1:1108 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1508
Mailing Address - Country:US
Mailing Address - Phone:641-621-1487
Mailing Address - Fax:641-621-1601
Practice Address - Street 1:1108 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1508
Practice Address - Country:US
Practice Address - Phone:641-621-1487
Practice Address - Fax:641-621-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA213792080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA35603OtherWELLMARK
35603OtherWELLMARK
IA2192369Medicaid
A01946Medicare UPIN
IA2192369Medicaid
IA35603OtherWELLMARK