Healthcare Provider Details

I. General information

NPI: 1043278583
Provider Name (Legal Business Name): WILLIAM RUBIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31046 UTICA RD
FRASER MI
48026-2534
US

IV. Provider business mailing address

31046 UTICA RD
FRASER MI
48026-2534
US

V. Phone/Fax

Practice location:
  • Phone: 586-294-5010
  • Fax: 586-294-8180
Mailing address:
  • Phone: 586-294-5010
  • Fax: 586-294-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberWR001017
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: