Provider Demographics
NPI:1003063025
Name:RUGGIERO, GAYLE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:ANNE
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-5200
Mailing Address - Country:US
Mailing Address - Phone:269-387-3290
Mailing Address - Fax:269-387-4494
Practice Address - Street 1:1903 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5200
Practice Address - Country:US
Practice Address - Phone:269-387-3290
Practice Address - Fax:269-387-4494
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0921792084P0800X
MI43011019582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540C913500OtherBCBSM DME
MI700C947350OtherBCBS OF MICHIGAN
MI1003063025Medicaid
MI690C900880OtherBCBSM LAB
MI700C947350OtherBCBS OF MICHIGAN
MI1003063025Medicaid