Provider Demographics
NPI:1770687089
Name:WALKOTTEN, RUTH A (DO)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:A
Last Name:WALKOTTEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2947 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-8598
Mailing Address - Country:US
Mailing Address - Phone:231-733-1989
Mailing Address - Fax:231-739-7542
Practice Address - Street 1:2947 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445
Practice Address - Country:US
Practice Address - Phone:231-733-1989
Practice Address - Fax:231-766-3230
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2019-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIRW 009424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111775864Medicaid
MI5610016Medicare PIN