1508808338 NPI number — ADAM JON RUBINSTEIN M.D.

Table of content: ADAM JON RUBINSTEIN M.D. (NPI 1508808338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508808338 NPI number — ADAM JON RUBINSTEIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBINSTEIN
Provider First Name:
ADAM
Provider Middle Name:
JON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508808338
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 FORD PL STE 2E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48202-3450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-874-4806
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2799 W GRAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48202-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-874-4806
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301063679 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 4301063679 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003362600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036789800 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5996516 . This is a "AETNA NONHMO" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 010172772 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252062 . This is a "KAISER" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 3879713 . This is a "AETNA HMO" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 717825 . This is a "NCPPO" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 178808 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0164 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".