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General NPI Number Information
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NPI Number | 1184895310
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Entity Type | Organization
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Legal Business Name | MEDI DOC INC
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Dates
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Enumeration Date | 03/15/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 5200 SUFFIELD CT
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City | SKOKIE
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State | IL
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Zip | 60077-1527
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Country | US
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Telephone | 847-583-8427
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 SUFFIELD CT
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City | SKOKIE
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State | IL
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Zip | 60077-1527
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Country | US
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Telephone | 847-583-8427
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HOWARD RUBIN
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Credential | MD
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Telephone | 847-583-8427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036042276
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License Number State | IL
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