Provider Demographics
NPI:1558413294
Name:RUBENSTEIN, JONATHAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:B
Last Name:RUBENSTEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 918
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-942-2734
Mailing Address - Fax:312-942-2156
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 918
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-2734
Practice Address - Fax:312-942-2156
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036 064796207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064796Medicaid
IL036064796Medicaid