Healthcare Provider Details

I. General information

NPI: 1609830397
Provider Name (Legal Business Name): BERNARD R RUBIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 W GRAND BLVD RHEUMATOLOGY - NCO 8
DETROIT MI
48202-3046
US

IV. Provider business mailing address

3031 W GRAND BLVD RHEUMATOLOGY - NCO 8
DETROIT MI
48202-3046
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2646
  • Fax:
Mailing address:
  • Phone: 313-916-2646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number5101019001
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: