Active NPI
Daniel S Rubin
- Pediatrics Physician
- Minnetonka, MN
National Provider Identifier
1740266675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 42058
- Practice address
- 15111 Twelve Oaks Ctr Dr
Park Nicollet Clinic - Carlson
Minnetonka, MN 55305 - Phone
- (952) 993-4500
- Fax
- (952) 993-4730
- NPI assigned
- Dec 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 42058 | MN | Primary |
Addresses
Primary practice location
15111 Twelve Oaks Ctr Dr
Park Nicollet Clinic - Carlson
Minnetonka, MN 55305
Mailing address
6465 Wayzata Blvd
Ste 315
St Louis Park, MN 55426-1728
Phone (952) 993-7169
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42058 | MN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318204800000",
"number": "1740266675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6465 WAYZATA BLVD",
"address_2": "STE 315",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554261728",
"telephone_number": "952-993-7169",
"fax_number": "952-993-0300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15111 TWELVE OAKS CTR DR",
"address_2": "PARK NICOLLET CLINIC - CARLSON",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "55305",
"telephone_number": "952-993-4500",
"fax_number": "952-993-4730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUBIN",
"first_name": "DANIEL",
"middle_name": "S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-22",
"last_updated": "2011-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "42058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.