Provider Demographics
NPI:1821519547
Name:RUTKOWSKI, LESLIE (DO)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7288
Mailing Address - Country:US
Mailing Address - Phone:334-361-3090
Mailing Address - Fax:334-361-2090
Practice Address - Street 1:204 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7288
Practice Address - Country:US
Practice Address - Phone:334-361-3090
Practice Address - Fax:334-361-2090
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-3421390200000X
ALDO.2354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program