Provider Demographics
NPI:1649774779
Name:RUBIN, EMIKO YUZAWA (PA-C)
Entity Type:Individual
Prefix:
First Name:EMIKO
Middle Name:YUZAWA
Last Name:RUBIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 E ERIE ST STE 1950
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3907
Mailing Address - Country:US
Mailing Address - Phone:312-926-3185
Mailing Address - Fax:312-926-7382
Practice Address - Street 1:259 E ERIE ST STE 1950
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3907
Practice Address - Country:US
Practice Address - Phone:312-926-3185
Practice Address - Fax:312-926-7382
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085006492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant