Provider Demographics
NPI:1407025059
Name:GARY V RUBIN MD
Entity Type:Organization
Organization Name:GARY V RUBIN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BUDVAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-229-8818
Mailing Address - Street 1:7001 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2201
Mailing Address - Country:US
Mailing Address - Phone:773-229-8818
Mailing Address - Fax:773-229-8423
Practice Address - Street 1:7001 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2201
Practice Address - Country:US
Practice Address - Phone:773-229-8818
Practice Address - Fax:773-229-8423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0533230001Medicare NSC