Basic Information
| Provider Information | |||||||||
| NPI: | 1295848570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUBRIGHT | ||||||||
| FirstName: | ERIK | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 5TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | GLADSTONE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498371929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064283273 | ||||||||
| FaxNumber: | 9064281881 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 5TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | GLADSTONE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498371929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064283273 | ||||||||
| FaxNumber: | 9064281881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101013406 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1295848570 | 05 | MI | MEDICAID | 080114637 | 01 | MI | RR MEDICARE GROUP#CC2139 | OTHER | 3422667 | 05 | MI | MEDICAID |