Provider Demographics
NPI:1801828025
Name:RUBY, ALAN JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JOEL
Last Name:RUBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2000 N HURON RIVER DR STE 100200
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1699
Mailing Address - Country:US
Mailing Address - Phone:734-572-1200
Mailing Address - Fax:734-572-9760
Practice Address - Street 1:3555 W 13 MILE RD
Practice Address - Street 2:LL-20
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-288-2280
Practice Address - Fax:248-288-5644
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051388207W00000X, 207WX0107X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1801828025Medicaid
MI0Q26082022Medicare PIN
E79267Medicare UPIN
MI0Q26082022Medicare PIN
MI4904910Medicaid
381946761OtherGROUP TAX ID #
E79267Medicare UPIN
MI3453592Medicaid