Provider Demographics
NPI:1376504605
Name:RUOTSI, LEE CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:CHARLES
Last Name:RUOTSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2625 HARLEM RD
Mailing Address - Street 2:SUITE #120
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4031
Mailing Address - Country:US
Mailing Address - Phone:716-891-2570
Mailing Address - Fax:716-891-2470
Practice Address - Street 1:2625 HARLEM RD
Practice Address - Street 2:SUITE #120
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4031
Practice Address - Country:US
Practice Address - Phone:716-891-2570
Practice Address - Fax:716-891-2470
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175439207Q00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE34072Medicare UPIN
NY11357AMedicare ID - Type Unspecified