Provider Demographics
NPI:1760501563
Name:H REX RUETTINGER D O P C
Entity Type:Organization
Organization Name:H REX RUETTINGER D O P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-561-4540
Mailing Address - Street 1:8623 N TELEGRAPH RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1489
Mailing Address - Country:US
Mailing Address - Phone:313-561-4540
Mailing Address - Fax:313-561-9515
Practice Address - Street 1:8623 N TELEGRAPH RD
Practice Address - Street 2:SUITE #1
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1489
Practice Address - Country:US
Practice Address - Phone:313-561-4540
Practice Address - Fax:313-561-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M36851Medicare ID - Type UnspecifiedMEDICARE GROUP #