=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346469665
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL S RABIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 HOSPITAL DRIVE
-----------------------------------------------------
City | SASKATOON
-----------------------------------------------------
State | SK
-----------------------------------------------------
Zip | S7N0W8
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone | 306-655-2396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 OBER RD
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02459-3141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 306-655-2396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 43167
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------