Provider Demographics
NPI:1669704490
Name:DR RUTHIE MCCRARY MD PC
Entity type:Organization
Organization Name:DR RUTHIE MCCRARY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-530-2566
Mailing Address - Street 1:390 PARK ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-3400
Mailing Address - Country:US
Mailing Address - Phone:248-258-5100
Mailing Address - Fax:
Practice Address - Street 1:390 PARK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-3400
Practice Address - Country:US
Practice Address - Phone:248-258-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077899208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty