Provider Demographics
NPI:1437184207
Name:WORTHINGTON, RUTH ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ANN
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:B545 WEST FEE HALL
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1315
Mailing Address - Country:US
Mailing Address - Phone:517-353-3100
Mailing Address - Fax:
Practice Address - Street 1:1600 W GD RIVER AVE
Practice Address - Street 2:STE 2
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864
Practice Address - Country:US
Practice Address - Phone:517-349-6560
Practice Address - Fax:517-349-5796
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007398208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3343803Medicaid
MI3343803Medicaid