Provider Demographics
NPI:1386689842
Name:RUKSENIENE, INDRE (MD)
Entity Type:Individual
Prefix:
First Name:INDRE
Middle Name:
Last Name:RUKSENIENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INDRE
Other - Middle Name:
Other - Last Name:DIKCIUTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8220 N CREEK DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2288
Mailing Address - Country:US
Mailing Address - Phone:513-984-2284
Mailing Address - Fax:513-984-2478
Practice Address - Street 1:8220 N CREEK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2288
Practice Address - Country:US
Practice Address - Phone:513-984-2284
Practice Address - Fax:513-984-2478
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350763762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2253645Medicaid