Provider Demographics
NPI:1043278583
Name:RUBIN, WILLIAM (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31046 UTICA RD
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-2534
Mailing Address - Country:US
Mailing Address - Phone:586-294-5010
Mailing Address - Fax:586-294-8180
Practice Address - Street 1:31046 UTICA RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-2534
Practice Address - Country:US
Practice Address - Phone:586-294-5010
Practice Address - Fax:586-294-8180
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWR001017213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2116622Medicaid
MI4855013OtherBLUE CROSS BLUE SHIELD MI
MIT34042Medicare UPIN
MI5505013Medicare PIN
MI2116622Medicaid
MI1127260002Medicare NSC