Provider Demographics
NPI:1114187531
Name:ANJUM, RUBEENA (MD)
Entity Type:Individual
Prefix:
First Name:RUBEENA
Middle Name:
Last Name:ANJUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 YANKEE LN
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4095
Mailing Address - Country:US
Mailing Address - Phone:318-450-1240
Mailing Address - Fax:
Practice Address - Street 1:315 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1252
Practice Address - Country:US
Practice Address - Phone:812-421-7489
Practice Address - Fax:812-421-7497
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070559A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00018Medicaid
IN01070559AOtherIN LICENSE