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General NPI Number Information
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NPI Number | 1306854583
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Entity Type | Organization
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Legal Business Name | BRYAN RUBACH M D SC
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 1256 WATERFORD DR SUITE 170
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City | AURORA
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State | IL
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Zip | 60504-4510
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Country | US
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Telephone | 630-820-8653
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Fax | 630-820-7238
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Provider Business Mailing Address
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Address Line | 1256 WATERFORD DR SUITE 170
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City | AURORA
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State | IL
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Zip | 60504-4510
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Country | US
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Telephone | 630-820-8653
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Fax | 630-820-7238
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHELLE SABON
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Credential |
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Telephone | 630-820-8653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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