Provider Demographics
NPI:1063906667
Name:RUBY, HOLLY NICOLE (DO)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:NICOLE
Last Name:RUBY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32100 TELEGRAPH RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2408
Mailing Address - Country:US
Mailing Address - Phone:248-644-1221
Mailing Address - Fax:248-644-2748
Practice Address - Street 1:32100 TELEGRAPH RD STE 110
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2408
Practice Address - Country:US
Practice Address - Phone:248-644-1221
Practice Address - Fax:248-644-2748
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101026243208000000X
MI5101023836208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics