Provider Demographics
NPI:1922031400
Name:BRENT L. RUBIN & ASSOCIATES INC
Entity Type:Organization
Organization Name:BRENT L. RUBIN & ASSOCIATES INC
Other - Org Name:FOOT & ANKLE PHYSICIANS & SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-473-0125
Mailing Address - Street 1:3055 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4135
Mailing Address - Country:US
Mailing Address - Phone:419-473-0125
Mailing Address - Fax:419-473-1230
Practice Address - Street 1:3055 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4135
Practice Address - Country:US
Practice Address - Phone:419-473-0125
Practice Address - Fax:419-473-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2040740Medicaid
OH0558530001Medicare NSC
OH9276931Medicare PIN