Provider Demographics
NPI:1619986049
Name:RUBLE, CHERYL A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:A
Last Name:RUBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:RUDNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2300 HAGGERTY RD
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2184
Mailing Address - Country:US
Mailing Address - Phone:248-668-0900
Mailing Address - Fax:248-926-9112
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 1010
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-668-0900
Practice Address - Fax:248-926-9112
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406400207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104406087Medicaid
MI104406087Medicaid
MION52330Medicare ID - Type Unspecified