Provider Demographics
NPI:1871577379
Name:SUBLA, MIR RAUF (MD)
Entity type:Individual
Prefix:
First Name:MIR
Middle Name:RAUF
Last Name:SUBLA
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:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5010
Mailing Address - Country:US
Mailing Address - Phone:701-857-5000
Mailing Address - Fax:
Practice Address - Street 1:400 BURDICK EXPY E
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4768
Practice Address - Country:US
Practice Address - Phone:701-857-7388
Practice Address - Fax:701-857-7332
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45871207RC0000X, 207RC0200X
IA40407207RC0000X
WI61329207RC0000X
MNMD-52871207RC0200X
ND16870207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH65106Medicare UPIN
MN810000136Medicare ID - Type Unspecified