Provider Demographics
NPI:1083639199
Name:RUPKE, STUART J (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:J
Last Name:RUPKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-583-6800
Mailing Address - Fax:989-583-6915
Practice Address - Street 1:1575 CONCENTRIC BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9312
Practice Address - Country:US
Practice Address - Phone:989-583-6800
Practice Address - Fax:989-583-6915
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301071163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381870664OtherPPOM
MI102436OtherGREAT LAKES HEALTH PLAN
MISR071163OtherLICENSE
MI080G376200OtherBCBSM
MI381870664OtherPRIORITY HEALTH
MI39202OtherCOMMUNITY CHOICE MICHIGAN
MI0730226OtherBCBSM
MI381870664OtherCOMMERCIAL
MI080119306OtherRAILROAD MEDICARE
MI1083639199Medicaid
MI381870664OtherHEALTH CARE ALLIANCE POOL
MI381870664OtherPRIVATE HEALTHCARE SYSTEM
MI4650563OtherAETNA
MI4650563OtherAETNA
MI381870664OtherPRIORITY HEALTH