Provider Demographics
NPI:1881696953
Name:RUBIN, LAWRENCE B (DPM)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:B
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18530 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2319
Mailing Address - Country:US
Mailing Address - Phone:313-273-9400
Mailing Address - Fax:313-273-5612
Practice Address - Street 1:18530 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2319
Practice Address - Country:US
Practice Address - Phone:313-273-9400
Practice Address - Fax:313-273-5612
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000839213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1524461Medicaid
MI1391060Medicaid
MIT34420Medicare UPIN
MIP55370001Medicare PIN