Provider Demographics
NPI: | 1477509610 |
---|---|
Name: | RUTILA, HAROLD E (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | HAROLD |
Middle Name: | E |
Last Name: | RUTILA |
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: | 13031 OLD BILMAR LN |
Mailing Address - Street 2: | |
Mailing Address - City: | GRAND BLANC |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48439-1939 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 810-232-8888 |
Mailing Address - Fax: | 810-232-9190 |
Practice Address - Street 1: | 1121 W HILL RD |
Practice Address - Street 2: | |
Practice Address - City: | FLINT |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48507-4733 |
Practice Address - Country: | US |
Practice Address - Phone: | 810-232-8888 |
Practice Address - Fax: | 810-232-9090 |
Is Sole Proprietor?: | Not Answered |
Enumeration Date: | 2006-05-26 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 4301059051 | 208800000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208800000X | Allopathic & Osteopathic Physicians | Urology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MI | 0102533022 | Other | HEALTHPLUS |
MI | F28398 | Other | HAP |
MI | MCARE | Other | C2280 |
MI | 086804 | Other | SELECTCARE |
MI | 223542 | Other | MCLAREN HEALTHPLAN |
MI | 223542 | Other | MCLAREN HEALTHPLAN |
MI | F28398 | Medicare UPIN |