Provider Demographics
NPI:1215023569
Name:RUCH, MICHAEL DAVID (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:RUCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 BURTON ST SE STE 106
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-4398
Mailing Address - Country:US
Mailing Address - Phone:616-957-2576
Mailing Address - Fax:616-957-2576
Practice Address - Street 1:3300 BURTON SE
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4398
Practice Address - Country:US
Practice Address - Phone:616-957-2576
Practice Address - Fax:616-957-2576
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005183103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical