Provider Demographics
NPI:1316111479
Name:DOCTOR HOWARD L DUBIN PC
Entity type:Organization
Organization Name:DOCTOR HOWARD L DUBIN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-548-9860
Mailing Address - Street 1:27483 DEQUINDRE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3491
Mailing Address - Country:US
Mailing Address - Phone:248-548-9860
Mailing Address - Fax:248-548-6278
Practice Address - Street 1:27483 DEQUINDRE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3491
Practice Address - Country:US
Practice Address - Phone:248-548-9860
Practice Address - Fax:248-548-6278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHD005576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1326052820Medicaid
MI1156313764OtherBCBS
MI5822231Medicare PIN
MI1326052820Medicaid