Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301073701 | MI |
NPI | 1023074960 |
---|---|
Provider Name | Cynthia K Rubert |
First Address | Prudenville, MI 48651-9624 |
Second Address | Prudenville, MI 48651-9624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 29/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200650032 | BXBS (01) | MI |
4120123 | (05) | MI |
G74407 | (02) |