Provider Demographics
NPI:1952533879
Name:EDWARD A, RUGIENIUS DPM, P.C.
Entity Type:Organization
Organization Name:EDWARD A, RUGIENIUS DPM, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUGIENIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-848-9160
Mailing Address - Street 1:27620 FARMINGTON RD
Mailing Address - Street 2:#103
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3349
Mailing Address - Country:US
Mailing Address - Phone:248-848-9160
Mailing Address - Fax:
Practice Address - Street 1:27620 FARMINGTON RD
Practice Address - Street 2:#103
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3349
Practice Address - Country:US
Practice Address - Phone:248-848-9160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000439213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8635236Medicare Oscar/Certification
MIT97181Medicare UPIN