Healthcare Provider Details

I. General information

NPI: 1023435203
Provider Name (Legal Business Name): ROBERT I. LUBIN, D.P.M., P. L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6512 N CANTON CENTER RD
CANTON MI
48187-1652
US

IV. Provider business mailing address

PO BOX 3299
FARMINGTON HILLS MI
48333-3299
US

V. Phone/Fax

Practice location:
  • Phone: 248-819-0249
  • Fax:
Mailing address:
  • Phone: 248-819-0249
  • Fax: 248-489-0545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5901000759
License Number StateMI

VIII. Authorized Official

Name: ROBERT LUBIN
Title or Position: DPM/OWNER
Credential:
Phone: 248-819-0249