Provider Demographics
NPI:1336196724
Name:BUBAK, MARK E (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:BUBAK
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:PO BOX 5126
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5126
Mailing Address - Country:US
Mailing Address - Phone:605-335-1952
Mailing Address - Fax:605-373-9971
Practice Address - Street 1:2200 W 49TH ST STE 104
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6550
Practice Address - Country:US
Practice Address - Phone:605-336-6385
Practice Address - Fax:605-336-6513
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD3512207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0007519OtherBCBS
MN73Q32BUOtherBCBS
SD5900042Medicaid
MN792302300Medicaid
IA1981852Medicaid
SD0007519OtherBCBS
MN73Q32BUOtherBCBS
E84703Medicare UPIN