Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | WR001017 | MI |
Y | 222Z00000X | Podiatrist | WR001017 | MI |
NPI | 1043278583 |
---|---|
Provider Name | William Rubin |
First Address | Fraser, MI 48026-2534 |
Second Address | Fraser, MI 48026-2534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 10/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2116622 | (05) | MI |
4855013 | BLUE CROSS BLUE SHIELD MI (01) | MI |
T34042 | (02) | MI |