Provider Demographics
NPI:1912140435
Name:RUTHERFORD, MICHAEL TODD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TODD
Other - Middle Name:
Other - Last Name:RUTHERFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:75 CLAREMONT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3585
Mailing Address - Country:US
Mailing Address - Phone:406-758-5155
Mailing Address - Fax:406-751-5166
Practice Address - Street 1:75 CLAREMONT ST
Practice Address - Street 2:SUITE C
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3585
Practice Address - Country:US
Practice Address - Phone:406-758-5155
Practice Address - Fax:406-751-5166
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT298382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry