1659341808 NPI number — DR. MICHAEL D. DUBRIWNY MD

Table of content: DR. MICHAEL D. DUBRIWNY MD (NPI 1659341808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659341808 NPI number — DR. MICHAEL D. DUBRIWNY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUBRIWNY
Provider First Name:
MICHAEL
Provider Middle Name:
D.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659341808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21228
Provider Second Line Business Mailing Address:
DEPARTMENT 31
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74121-1228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-491-5752
Provider Business Mailing Address Fax Number:
918-491-5753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6655 S YALE AVE
Provider Second Line Business Practice Location Address:
LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74136-3326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-491-5752
Provider Business Practice Location Address Fax Number:
918-491-5753
Provider Enumeration Date:
01/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  11361 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100059960A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4054284 . This is a "AETNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 72971 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".