Provider Demographics
NPI:1306863147
Name:GEORGE M RUTAN DPM
Entity Type:Organization
Organization Name:GEORGE M RUTAN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENHORWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-529-7800
Mailing Address - Street 1:3663 RIDGE MILL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7799
Mailing Address - Country:US
Mailing Address - Phone:614-529-7800
Mailing Address - Fax:513-529-7802
Practice Address - Street 1:3663 RIDGE MILL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7799
Practice Address - Country:US
Practice Address - Phone:614-529-7800
Practice Address - Fax:513-529-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001740213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2861541Medicaid
OHDD8097OtherRAILROAD GROUP NUMBER
OH2861541Medicaid
OHDD8097OtherRAILROAD GROUP NUMBER
OH9257045Medicare PIN