Provider Demographics
NPI:1215027420
Name:LUBIN, ROBERT I (DPM)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:I
Last Name:LUBIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3299
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-3299
Mailing Address - Country:US
Mailing Address - Phone:248-819-0249
Mailing Address - Fax:248-489-0545
Practice Address - Street 1:8552 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1310
Practice Address - Country:US
Practice Address - Phone:248-819-0249
Practice Address - Fax:248-489-0545
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRL000759213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4939521Medicaid
MI4939521Medicaid
MI5825245Medicare ID - Type Unspecified
MI6388420001Medicare NSC