Provider Demographics
NPI:1447202106
Name:RUKSENAS, AUDRIUS (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDRIUS
Middle Name:
Last Name:RUKSENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635739
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5739
Mailing Address - Country:US
Mailing Address - Phone:513-889-9902
Mailing Address - Fax:513-793-0729
Practice Address - Street 1:3572 FAWNRUN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-3832
Practice Address - Country:US
Practice Address - Phone:513-889-9902
Practice Address - Fax:513-793-0729
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074672207R00000X
OH35-074672207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00411495OtherRR MEDICARE
OH2123357Medicaid
OHP00337066OtherRAILROAD MEDICARE
OH2123357Medicaid
OHP00411495OtherRR MEDICARE
OH0883189Medicare PIN