Provider Demographics
NPI:1871829606
Name:MICHAEL N. RUTMAN, D.O., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL N. RUTMAN, D.O., A MEDICAL CORPORATION
Other - Org Name:MICHAEL N. RUTMAN, D.O., A MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NEALE
Authorized Official - Last Name:RUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-598-0088
Mailing Address - Street 1:2355 S MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-8788
Mailing Address - Country:US
Mailing Address - Phone:760-598-0088
Mailing Address - Fax:760-598-0078
Practice Address - Street 1:2355 S MELROSE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8788
Practice Address - Country:US
Practice Address - Phone:760-598-0088
Practice Address - Fax:760-598-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4641207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP915AMedicare PIN
CAB58248Medicare UPIN