Provider Demographics
NPI:1184941841
Name:RUFF, STACEY MARIE (DO)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MARIE
Last Name:RUFF
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 1:1949 W 12 MILE RD
Mailing Address - Street 2:#100
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1868
Mailing Address - Country:US
Mailing Address - Phone:248-551-8305
Mailing Address - Fax:248-551-1245
Practice Address - Street 1:1949 W 12 MILE RD
Practice Address - Street 2:#100
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1868
Practice Address - Country:US
Practice Address - Phone:248-551-1756
Practice Address - Fax:248-551-9566
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018589207Q00000X, 207QH0002X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine