Provider Demographics
NPI:1760686000
Name:ROBERT I. LUBIN, D.P.M., P. L.L.C
Entity Type:Organization
Organization Name:ROBERT I. LUBIN, D.P.M., P. L.L.C
Other - Org Name:ALL PODIATRY P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:LUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-819-0429
Mailing Address - Street 1:PO BOX 3299
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-3299
Mailing Address - Country:US
Mailing Address - Phone:248-819-0249
Mailing Address - Fax:248-489-0545
Practice Address - Street 1:8552 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1310
Practice Address - Country:US
Practice Address - Phone:248-819-0249
Practice Address - Fax:248-489-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRL000759213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4939521Medicaid
MIT19143Medicare UPIN
MI6213620001Medicare NSC
0P53910Medicare PIN