Provider Demographics
NPI:1396722328
Name:TRYBULA, MARION A (MD)
Entity type:Individual
Prefix:DR
First Name:MARION
Middle Name:A
Last Name:TRYBULA
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 1:200 E 89TH AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7319
Mailing Address - Country:US
Mailing Address - Phone:219-736-2800
Mailing Address - Fax:219-736-6680
Practice Address - Street 1:200 E 89TH AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7319
Practice Address - Country:US
Practice Address - Phone:219-736-2800
Practice Address - Fax:219-736-6680
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045710207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000085042OtherUNICARE
238805OtherHARMONY HEALTH
830003898OtherTRAVELERS MEDICARE
9210030OtherADVOCATE PHO
200101980AOtherMOLINA
IL91115213OtherBLUE CROSS/BLUE SHIELD
000000085042OtherINDIANA CARPENTERS
IN200101980Medicaid
IN000000085042OtherANTHEM
238805OtherWELLCARE
INB57214Medicare UPIN