Provider Demographics
NPI:1427057447
Name:MCKIBBEN, ANDREW WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WILLIAM
Last Name:MCKIBBEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:FAIRVIEW RANGE MEDICAL CENTER
Mailing Address - Street 2:750 E 34TH ST
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FAIRVIEW RANGE MEDICAL CENTER
Practice Address - Street 2:750 E 34TH ST
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2341
Practice Address - Country:US
Practice Address - Phone:612-672-2258
Practice Address - Fax:612-672-6041
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2016-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN36629207RC0200X, 207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203799325Medicaid
MOP00098988OtherRAILROAD MEDICARE
MOP00098988OtherRAILROAD MEDICARE
F77221Medicare UPIN