Provider Demographics
NPI:1417940057
Name:RUBINO, DON (MD)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:RUBINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DON
Other - Middle Name:MARINO
Other - Last Name:RUBINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1453 HICKORY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2057
Mailing Address - Country:US
Mailing Address - Phone:810-733-8187
Mailing Address - Fax:
Practice Address - Street 1:1453 HICKORY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-2057
Practice Address - Country:US
Practice Address - Phone:810-733-8187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029987208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350B511580OtherBCBS OF MICHIGAN
MI4425242Medicaid
MIC1536OtherMCARE
MI4087818OtherAETNA
MIP71002OtherBLUE CARE NETWORK
MIN60840001Medicare ID - Type Unspecified
MIC1536OtherMCARE