Provider Demographics
NPI:1033223938
Name:RUBIN, MICHAEL HOTELLING (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HOTELLING
Last Name:RUBIN
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 1:1830 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4047
Mailing Address - Country:US
Mailing Address - Phone:336-765-0463
Mailing Address - Fax:336-768-9452
Practice Address - Street 1:1830 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4047
Practice Address - Country:US
Practice Address - Phone:336-765-0463
Practice Address - Fax:336-768-9452
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22042207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
73825OtherBLUE CROSS BLUE SHIELD
2901101OtherUNITEDHEALTHCARE
NC89-73825Medicaid
C86236Medicare UPIN
2901101OtherUNITEDHEALTHCARE