MEDICARE: DR. DEBORAH SUE RUARK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	4301064695	MI

General Provider Information

NPI Number	:	1124110382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH SUE RUARK MD

Provider Business Mailing Address
First Line	:	1866 LINCOLNSHIRE DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-4530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1866 LINCOLNSHIRE DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-4530
Country	:	US
Telephone Number	:	248-421-5076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	04/16/2024

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