Provider Demographics
NPI:1265765838
Name:RUBENSTEIN, MARC (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:RUBENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 E WALTON PL
Mailing Address - Street 2:UNIT 26
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1971
Mailing Address - Country:US
Mailing Address - Phone:847-544-5867
Mailing Address - Fax:847-544-5950
Practice Address - Street 1:159 E WALTON PL
Practice Address - Street 2:UNIT 26
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1971
Practice Address - Country:US
Practice Address - Phone:847-544-5867
Practice Address - Fax:847-544-5950
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047597174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13104002Medicare UPIN