Basic Information
| Provider Information | |||||||||
| NPI: | 1508808338 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUBINSTEIN | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | JON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FORD PL STE 2E | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482023450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138744806 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2799 W GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482022608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138744806 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 11/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 4301063679 | MI | N | Other Service Providers | Specialist | 207L00000X | 4301063679 | MI | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 3879713 | 01 | DC | AETNA HMO | OTHER | 003362600 | 05 | MD | MEDICAID | 010172772 | 05 | VA | MEDICAID | 036789800 | 05 | DC | MEDICAID | 178808 | 01 | VA | ANTHEM BCBS | OTHER | 252062 | 01 | DC | KAISER | OTHER | 0164 | 01 | DC | CAREFIRST BCBS | OTHER | 5996516 | 01 | DC | AETNA NONHMO | OTHER | 717825 | 01 | DC | NCPPO | OTHER |