Provider Demographics
NPI:1427050285
Name:RUBIN, MICHAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:RUBIN
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 1:8989 FOREST HILL IRENE CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-6619
Mailing Address - Country:US
Mailing Address - Phone:901-517-4048
Mailing Address - Fax:901-206-2216
Practice Address - Street 1:4500 SUNNY ISLE STE 9
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-778-1802
Practice Address - Fax:340-778-6460
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30943207RC0000X
MI4301116483207RC0000X
VI2603207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4099597OtherBCBS
TN3337923Medicaid
TN3337923Medicaid
TN4099597OtherBCBS