Provider Demographics
NPI:1073137279
Name:RUBEN, MAX ROLAND (MD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:ROLAND
Last Name:RUBEN
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 1:5359 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1450
Mailing Address - Country:US
Mailing Address - Phone:773-836-2785
Mailing Address - Fax:773-836-7381
Practice Address - Street 1:5359 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1450
Practice Address - Country:US
Practice Address - Phone:773-836-2785
Practice Address - Fax:773-836-7381
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.161824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine