Healthcare Provider Details

I. General information

NPI: 1538166434
Provider Name (Legal Business Name): ELIZABETH A DUBINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 SOUTH BLVD E STE 2400
ROCHESTER HILLS MI
48307
US

IV. Provider business mailing address

633 SOUTH BLVD E STE 2400
ROCHESTER HILLS MI
48307-5471
US

V. Phone/Fax

Practice location:
  • Phone: 248-879-5570
  • Fax: 248-879-2235
Mailing address:
  • Phone: 248-879-5570
  • Fax: 248-879-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301045659
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: