Healthcare Provider Details

I. General information

NPI: 1841721545
Provider Name (Legal Business Name): GABRIELLE RUBIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 W DEMPSTER ST
PARK RIDGE IL
60068-1186
US

IV. Provider business mailing address

1775 DEMPSTER ST
PARK RIDGE IL
60068-1143
US

V. Phone/Fax

Practice location:
  • Phone: 847-698-3600
  • Fax:
Mailing address:
  • Phone: 847-318-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036150888
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036150888
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: