Provider Demographics
NPI:1215906763
Name:RUBIN, KIRSTEN L (MD)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:L
Last Name:RUBIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:L
Other - Last Name:FROBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-355-7199
Mailing Address - Fax:317-355-9022
Practice Address - Street 1:7910 E WASHINGTON ST STE 210
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-6803
Practice Address - Country:US
Practice Address - Phone:317-355-5437
Practice Address - Fax:317-355-9047
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057595A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200442720Medicaid
IN000000733941OtherANTHEM
IN200442720Medicaid