Provider Demographics
NPI:1205824505
Name:RUBIN, MICHAEL NATHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NATHAN
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5584 WILLOW VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1803
Mailing Address - Country:US
Mailing Address - Phone:248-851-5736
Mailing Address - Fax:248-851-5736
Practice Address - Street 1:5584 WILLOW VALLEY DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1803
Practice Address - Country:US
Practice Address - Phone:248-851-5736
Practice Address - Fax:248-851-5736
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006206207RC0000X
AZ006628207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1099910Medicaid
MION27220Medicare ID - Type Unspecified
MIE38420Medicare UPIN