Provider Demographics
NPI:1245303122
Name:RUTMAN, MICHAEL NEALE (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NEALE
Last Name:RUTMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2355 S MELROSE DR
Mailing Address - Street 2:SUITE #502
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-8788
Mailing Address - Country:US
Mailing Address - Phone:760-942-2524
Mailing Address - Fax:760-942-1657
Practice Address - Street 1:317 NO. EL CAMINO REAL
Practice Address - Street 2:SUITE #502
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2811
Practice Address - Country:US
Practice Address - Phone:760-942-2524
Practice Address - Fax:760-942-1657
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2016-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A4641207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX46410Medicaid
CA00AX46410Medicaid
CAB58248Medicare UPIN
CAB58248Medicare PIN
B58248Medicare UPIN