Individual
ALBERT J DERUBERTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
301 W HOMER ST, MICHIGAN CITY, IN 46360-4358
(219) 879-8511
Mailing address
301 W HOMER ST, MICHIGAN CITY, IN 46360-4358
(219) 879-8511
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
020-04394A
IN
208100000X
Physical Medicine & Rehabilitation Physician
036081549
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036081549
—
IL
01
—
4673170001
DMERC GROUP
IL
Enumeration date
05/27/2006
Last updated
07/09/2015
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