Provider Demographics
NPI:1154358190
Name:RUBENSTEIN, SAUL M (MD)
Entity type:Individual
Prefix:
First Name:SAUL
Middle Name:M
Last Name:RUBENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1988 SHORE HILL DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1254
Mailing Address - Country:US
Mailing Address - Phone:248-858-8465
Mailing Address - Fax:
Practice Address - Street 1:6875 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2008
Practice Address - Country:US
Practice Address - Phone:248-625-5922
Practice Address - Fax:248-625-2013
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301027623207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1806371261OtherBCBS OF MICHIGAN PIN
4381538OtherAETNA
MI2105914Medicaid
F37294006Medicare ID - Type Unspecified
4381538OtherAETNA