Healthcare Provider Details

I. General information

NPI: 1366629594
Provider Name (Legal Business Name): LAWRENCE B RUBIN DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18530 GRAND RIVER
DETROIT MI
48223
US

IV. Provider business mailing address

18530 GRAND RIVER
DETROIT MI
48223
US

V. Phone/Fax

Practice location:
  • Phone: 313-273-9400
  • Fax: 313-273-5612
Mailing address:
  • Phone: 313-273-9400
  • Fax: 313-273-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901000839
License Number StateMI

VIII. Authorized Official

Name: LAWRENCE BLAKE RUBIN
Title or Position: PRESIDENT OWNER
Credential: DPM
Phone: 313-273-9400