Healthcare Provider Details

I. General information

NPI: 1376981290
Provider Name (Legal Business Name): CARL RUEBEN JAY JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43494 WOODWARD AVE STE 208
BLOOMFIELD HILLS MI
48302-5054
US

IV. Provider business mailing address

43494 WOODWARD AVE STE 208
BLOOMFIELD HILLS MI
48302-5054
US

V. Phone/Fax

Practice location:
  • Phone: 810-206-1402
  • Fax:
Mailing address:
  • Phone: 810-206-1402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002483
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: