Provider Demographics
NPI:1568554087
Name:RUBIN, ADAM D (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:D
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21000 E 12 MILE RD
Mailing Address - Street 2:STE 111
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081
Mailing Address - Country:US
Mailing Address - Phone:586-779-7310
Mailing Address - Fax:586-445-2523
Practice Address - Street 1:21000 E 12 MILE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1116
Practice Address - Country:US
Practice Address - Phone:586-779-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAR072598207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0405015491OtherBLUE CROSS BLUE SHIELD
0501549OtherBLUE CARE NETWORK
139782OtherCARE CHOICES
7883549OtherAETNA
16768OtherMCAR
7234039OtherCIGNA
I18665OtherHEALTH ALLIANCE PLAN
MI4635114Medicaid
P00217135OtherRAILROAD MEDICARE
7883549OtherAETNA