Provider Demographics
NPI:1346354958
Name:RUPPRECHT, DALE G (PA)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:G
Last Name:RUPPRECHT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1667 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1809
Mailing Address - Country:US
Mailing Address - Phone:517-349-9551
Mailing Address - Fax:517-349-7650
Practice Address - Street 1:1667 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1809
Practice Address - Country:US
Practice Address - Phone:517-349-9551
Practice Address - Fax:517-349-7650
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001704363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN82480002Medicare ID - Type Unspecified