Individual
DR. ANDREW WILLIAM MCKIBBEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
FAIRVIEW RANGE MEDICAL CENTER, 750 E 34TH ST, HIBBING, MN 55746-2341
(612) 672-2258
(612) 672-6041
Mailing address
FAIRVIEW RANGE MEDICAL CENTER, 750 E 34TH ST, HIBBING, MN 55746-2341
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
36629
MN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
36629
MN
207RP1001X
Pulmonary Disease Physician
36629
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203799325
—
MO
01
—
P00098988
RAILROAD MEDICARE
MO
Enumeration date
07/20/2005
Last updated
02/23/2016
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