Provider Demographics
NPI:1124131768
Name:RUBIN, JEFFERY C (MD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:C
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 ROYAL OAK CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-2938
Mailing Address - Country:US
Mailing Address - Phone:773-671-8370
Mailing Address - Fax:815-346-5803
Practice Address - Street 1:848 DODGE AVE STE 228
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1506
Practice Address - Country:US
Practice Address - Phone:773-671-8370
Practice Address - Fax:815-346-5803
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091487207Q00000X
IL036-091487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
L59621Medicare ID - Type Unspecified
D60018Medicare UPIN