MEDICARE: BERNARD R RUBIN DO

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	207RR0500X	Rheumatology Physician	5101019001	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	660000436	OTHER	TX	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	842571	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609830397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARD R RUBIN DO

Provider Business Mailing Address
First Line	:	3031 W GRAND BLVD
Second Line	:	RHEUMATOLOGY - NCO 8
City	:	DETROIT
State	:	MI
Zip	:	48202-3046
Country	:	US
Telephone Number	:	313-916-2646
Fax Number	:

Provider Business Practice Location Address
First Line	:	3031 W GRAND BLVD
Second Line	:	RHEUMATOLOGY - NCO 8
City	:	DETROIT
State	:	MI
Zip	:	48202-3046
Country	:	US
Telephone Number	:	313-916-2646
Fax Number	:

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	07/25/2010

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