Provider Demographics
NPI:1023074960
Name:RUBERT, CYNTHIA K (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:K
Last Name:RUBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:K
Other - Last Name:RUBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC
Mailing Address - Street 1:2585 W HOUGHTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PRUDENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48651-9624
Mailing Address - Country:US
Mailing Address - Phone:989-366-2900
Mailing Address - Fax:989-366-1166
Practice Address - Street 1:2585 W HOUGHTON LAKE DR
Practice Address - Street 2:
Practice Address - City:PRUDENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48651-9624
Practice Address - Country:US
Practice Address - Phone:989-366-2900
Practice Address - Fax:989-366-1166
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073701207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200650032OtherBXBS
MI4120123Medicaid
MI0M84370Medicare ID - Type Unspecified
MI4120123Medicaid