Provider Demographics
NPI:1952356503
Name:RUTCHIK, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:RUTCHIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2968
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46515-2968
Mailing Address - Country:US
Mailing Address - Phone:574-296-3200
Mailing Address - Fax:574-296-3392
Practice Address - Street 1:410 PARK PL STE B
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3557
Practice Address - Country:US
Practice Address - Phone:574-855-5800
Practice Address - Fax:574-855-5805
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057389208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200443540Medicaid
INP00038154OtherMEDICARE RAILROAD
IN021236800OtherFEDERAL BLACK LUNG
IN187780CMedicare PIN
INP00038154OtherMEDICARE RAILROAD
IN021236800OtherFEDERAL BLACK LUNG
ING74303Medicare UPIN
IN187730HMedicare PIN