Provider Demographics
NPI:1619649100
Name:JADHAV, RUTUJA HAMBIRRAO (MS)
Entity Type:Individual
Prefix:DR
First Name:RUTUJA
Middle Name:HAMBIRRAO
Last Name:JADHAV
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 PONTIAC LAKE RD STE D42160
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2761
Mailing Address - Country:US
Mailing Address - Phone:248-683-2300
Mailing Address - Fax:
Practice Address - Street 1:2335 PONTIAC LAKE RD STE D
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2761
Practice Address - Country:US
Practice Address - Phone:248-683-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program