MEDICARE: RANDI E RUBENZIK MD

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	207N00000X	Dermatology Physician	26180	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	070013969	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1Z5232	OTHER	AZ	HEALTH NET
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	99S007000006	OTHER	AZ	MEDISUN
5	1588612964	OTHER	AZ	AHCCCS
6	1995262	OTHER	AZ	UNITED HEALTHCARE
8	7096132	OTHER	AZ	AETNA
9	188961600	OTHER	AZ	DEPT OF LABOR WORK COMP

General Provider Information

NPI Number	:	1588612964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI E RUBENZIK MD

Provider Business Mailing Address
First Line	:	11130 N TATUM BLVD STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-1630
Country	:	US
Telephone Number	:	602-494-1817
Fax Number	:	602-494-7103

Provider Business Practice Location Address
First Line	:	11130 N TATUM BLVD STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-1630
Country	:	US
Telephone Number	:	602-494-1817
Fax Number	:	602-494-7103

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	04/13/2022

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Directions to “ RANDI E RUBENZIK MD” Practice Location

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