Provider Demographics
NPI:1255329470
Name:RUBENFELD, ARI B (MD)
Entity Type:Individual
Prefix:DR
First Name:ARI
Middle Name:B
Last Name:RUBENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 W TAYLOR ST
Mailing Address - Street 2:RM 2.42
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7242
Mailing Address - Country:US
Mailing Address - Phone:312-996-6584
Mailing Address - Fax:312-996-1282
Practice Address - Street 1:1855 W TAYLOR ST
Practice Address - Street 2:RM 2.42
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7242
Practice Address - Country:US
Practice Address - Phone:312-996-6584
Practice Address - Fax:312-996-1282
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-111652207YX0905X
WI5745520174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-111652-1Medicaid
ILI17276Medicare UPIN
IL036-111652-1Medicaid