Healthcare Provider Details

I. General information

NPI: 1124150602
Provider Name (Legal Business Name): MICHELE ANN RUBIN APN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE MC 5094
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

2914 HINTZE CT
JOLIET IL
60435-2990
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-3711
  • Fax:
Mailing address:
  • Phone: 815-744-7457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209-003294
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: