Provider Demographics
NPI:1659387355
Name:RUBIN, SHELDON ZALMON (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:ZALMON
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-1964
Mailing Address - Country:US
Mailing Address - Phone:708-598-0292
Mailing Address - Fax:708-598-2952
Practice Address - Street 1:8100 W 95TH ST
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-1964
Practice Address - Country:US
Practice Address - Phone:708-598-0292
Practice Address - Fax:708-598-2952
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-002714213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-002714Medicaid
ILT36916Medicare UPIN
IL0776500002Medicare NSC
IL0776500001Medicare NSC
IL521073Medicare PIN
IL016-002714Medicaid