Provider Demographics
NPI:1821261223
Name:RUCHALSKI, TINA BOLEK (MD,)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:BOLEK
Last Name:RUCHALSKI
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:MONIQUE
Other - Last Name:BOLEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:DESK A-10
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-6348
Mailing Address - Fax:216-445-1654
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:DESK A-10
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-6348
Practice Address - Fax:216-445-1654
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0912942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology