NPIMap

Organization Active NPI

Medical Mobile Podiatry, PLLC

  • Podiatrist
  • Southfield, MI
National Provider Identifier
1013347244
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
5901000839 Issued in MI
Legal business name
MEDICAL MOBILE PODIATRY, PLLC
Practice address
24293 Telegraph Rd Ste 212
Southfield, MI 48033-7903
Phone
(734) 493-1662
NPI assigned
Nov 26, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Lawrence B RubinNPI 1881696953
Title
Medical Director
Phone
(313) 273-9400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X 5901000839 MI Primary

Addresses

Primary practice location

24293 Telegraph Rd Ste 212
Southfield, MI 48033-7903

Mailing address

18530 Grand River Ave
Detroit, MI 48223-2319
Phone (313) 273-9400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140130001230 MI Part B Supplier - Clinic/Group Practice 2668601253 Receives reassigned benefits from 8 practitioners
Practice locations: Bingham Farms, MI

National Provider Directory

National Provider Directory

Locations

18530 Grand River Ave
Detroit, MI 48223
Phone (248) 210-5257

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1013347244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18530 GRAND RIVER AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482232319",
            "telephone_number": "313-273-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24293 TELEGRAPH RD STE 212",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480337903",
            "telephone_number": "734-493-1662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL MOBILE PODIATRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-26",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "RUBIN",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "313-273-9400",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "MI",
            "license": "5901000839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.