Provider Demographics
NPI:1528067600
Name:WRUBEL, DANIEL N (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:N
Last Name:WRUBEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 UNION ST
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:136 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-1230
Practice Address - Country:US
Practice Address - Phone:517-663-2020
Practice Address - Fax:517-663-5290
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002779152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000001060OtherPHYSICIAN HEALTH PLAN
MI1011804OtherMCLAREN HEALTH ADVANTAGE
MI5041390001OtherADMINISTAR FEDERAL
MIU29905Medicare UPIN
MION80250001Medicare ID - Type Unspecified