Provider Demographics
NPI:1801436753
Name:MITCHELL HUEBNER, MD
Entity type:Organization
Organization Name:MITCHELL HUEBNER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HUEBNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-361-2277
Mailing Address - Street 1:5477 GLEN LAKES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4381
Mailing Address - Country:US
Mailing Address - Phone:214-361-2277
Mailing Address - Fax:214-361-2273
Practice Address - Street 1:5477 GLEN LAKES DR STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4381
Practice Address - Country:US
Practice Address - Phone:214-361-2277
Practice Address - Fax:214-361-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care