Provider Demographics
NPI:1578670956
Name:RUEBECK, DAVID F (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:RUEBECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 FRANCE AVE S STE 350
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2120
Mailing Address - Country:US
Mailing Address - Phone:952-920-2600
Mailing Address - Fax:952-920-2668
Practice Address - Street 1:6545 FRANCE AVE S STE 350
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2120
Practice Address - Country:US
Practice Address - Phone:952-920-2600
Practice Address - Fax:952-920-2668
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40133208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN230723500Medicaid
240000148Medicare ID - Type Unspecified
G44297Medicare UPIN