Basic Information
| Provider Information | |||||||||
| NPI: | 1740376714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUBEN | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | ERIC | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 HAGGERTY RD | ||||||||
| Address2: | SUITE 1190 | ||||||||
| City: | WEST BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486249800 | ||||||||
| FaxNumber: | 2486249828 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 HAGGERTY RD | ||||||||
| Address2: | SUITE 1190 | ||||||||
| City: | WEST BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486249800 | ||||||||
| FaxNumber: | 2486249828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 05/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 4301050401 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 2738650 | 05 | MI | MEDICAID |