Provider Demographics
NPI:1104055169
Name:RUBIN, MARK N (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:N
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22285 N. PEPPER ROAD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2538
Mailing Address - Country:US
Mailing Address - Phone:847-882-6604
Mailing Address - Fax:847-882-6228
Practice Address - Street 1:22285 N. PEPPER ROAD
Practice Address - Street 2:SUITE 401
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2538
Practice Address - Country:US
Practice Address - Phone:847-882-6604
Practice Address - Fax:847-882-6228
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-127062084N0400X
MS271902084N0400X
IL0361381972084N0400X
MN53173207R00000X
MN513732084N0400X
TN595862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHN207ZMedicare PIN
MN130001555Medicare PIN