Healthcare Provider Details

I. General information

NPI: 1104055169
Provider Name (Legal Business Name): MARK N. RUBIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 W GRAND AVE STE B
CHICAGO IL
60612-1577
US

IV. Provider business mailing address

2045 W GRAND AVE STE B
CHICAGO IL
60612-1577
US

V. Phone/Fax

Practice location:
  • Phone: 630-447-0561
  • Fax:
Mailing address:
  • Phone: 630-447-0561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number36.138197
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number36.138197
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: