MEDICARE: DR. DOUGLAS HOWARD RUBEN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	005858	MI

General Provider Information

NPI Number	:	1295818763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS HOWARD RUBEN PH.D.

Provider Business Mailing Address
First Line	:	4211 OKEMOS RD STE 22
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-3287
Country	:	US
Telephone Number	:	517-347-0944
Fax Number	:	517-347-0944

Provider Business Practice Location Address
First Line	:	4211 OKEMOS RD STE 22
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-3287
Country	:	US
Telephone Number	:	517-347-0944
Fax Number	:	517-347-0944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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