Healthcare Provider Details

I. General information

NPI: 1871905703
Provider Name (Legal Business Name): SANDER RUBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33200 W 14 MILE RD STE 220
WEST BLOOMFIELD MI
48322-3586
US

IV. Provider business mailing address

26211 CENTRAL PARK BLVD STE 201
SOUTHFIELD MI
48076-4158
US

V. Phone/Fax

Practice location:
  • Phone: 248-855-7400
  • Fax: 248-626-6481
Mailing address:
  • Phone: 248-845-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number4301514768
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: