Provider Demographics
NPI:1811997463
Name:LICHT, RUTH MARIE (DO)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:MARIE
Last Name:LICHT
Suffix:
Gender:
Credentials:DO
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:MARIE
Other - Last Name:KRAUSENECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:4117 RED MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-8636
Mailing Address - Country:US
Mailing Address - Phone:989-245-2316
Mailing Address - Fax:989-624-1506
Practice Address - Street 1:3400 N. CENTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603
Practice Address - Country:US
Practice Address - Phone:989-624-1500
Practice Address - Fax:989-624-1506
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010453207Q00000X
MI010453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0150900525OtherHEALTHPLUS
MH4219244OtherAETNA
MIOG31024OtherBCN
MI080110138OtherRR MEDICARE
MI0G310240OtherBCBS
MI4506206Medicaid
MI4506206Medicaid
MI0N43130Medicare PIN