Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | L0341 | TX |
NPI | 1225067887 |
---|---|
Provider Name | Michael Klebuc |
First Address | Houston, TX 77030-2761 |
Second Address | Houston, TX 77030-2761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 07/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8EJ460 | BLUE CROSS BLUE SHIELD (01) | TX |
8S5862 | BCBS (01) | TX |