Provider Demographics
NPI:1225171614
Name:MIAN, RUBEENA H (MD)
Entity Type:Individual
Prefix:
First Name:RUBEENA
Middle Name:H
Last Name:MIAN
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 1:545 PLAINFIELD RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7600
Mailing Address - Country:US
Mailing Address - Phone:630-863-0648
Mailing Address - Fax:630-321-2298
Practice Address - Street 1:545 PLAINFIELD RD
Practice Address - Street 2:SUITE E
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7600
Practice Address - Country:US
Practice Address - Phone:630-863-0648
Practice Address - Fax:630-321-2298
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360874752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087475Medicaid
IL036087475Medicaid
IL205183Medicare ID - Type Unspecified