Provider Demographics
NPI:1467447490
Name:RUBIN, LEIGH KEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:KEN
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:35210 NANKIN BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7217
Mailing Address - Country:US
Mailing Address - Phone:734-525-2555
Mailing Address - Fax:734-525-0514
Practice Address - Street 1:35210 NANKIN BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7217
Practice Address - Country:US
Practice Address - Phone:734-525-2555
Practice Address - Fax:734-525-0514
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901001889213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3450124Medicaid
MI3450124Medicaid