Provider Demographics
NPI:1083653711
Name:RUTHERFORD, ELIZABETH A (MD FACOG)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:MD FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 EAST US HIGHWAY 6
Mailing Address - Street 2:SUITE 330
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:219-462-6144
Mailing Address - Fax:219-465-1150
Practice Address - Street 1:85 EAST US HIGHWAY 6
Practice Address - Street 2:SUITE 330
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-462-6144
Practice Address - Fax:219-465-1150
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058124207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200455720Medicaid
INP00206705OtherMEDICARE RAILROAD
IN000000304744OtherBCBS
INP00206705OtherMEDICARE RAILROAD
IN200455720Medicaid