Healthcare Provider Details

I. General information

NPI: 1508561283
Provider Name (Legal Business Name): IVAN F RUBEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

5825 POWERS FERRY RD
ATLANTA GA
30327-4329
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3350
  • Fax: 404-712-6370
Mailing address:
  • Phone: 516-838-5895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number100871
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number100871
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number100871
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: