Provider Demographics
NPI:1104824549
Name:RUBIN, IRA S (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:S
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 95TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5040
Mailing Address - Country:US
Mailing Address - Phone:630-357-1030
Mailing Address - Fax:630-357-8027
Practice Address - Street 1:1012 95TH ST STE 7
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5040
Practice Address - Country:US
Practice Address - Phone:630-357-1030
Practice Address - Fax:630-357-8027
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071663208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071663Medicaid
IL036071663Medicaid