Provider Demographics
NPI:1225281058
Name:RONALD G. RUBIN, M.D., S.C.
Entity Type:Organization
Organization Name:RONALD G. RUBIN, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-271-3322
Mailing Address - Street 1:13128 N FOX HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-1805
Mailing Address - Country:US
Mailing Address - Phone:262-242-2226
Mailing Address - Fax:
Practice Address - Street 1:633 W WISCONSIN AVE
Practice Address - Street 2:SUITE 1810
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1918
Practice Address - Country:US
Practice Address - Phone:414-271-3322
Practice Address - Fax:414-271-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34320900Medicaid
WIWI153001Medicare PIN