MEDICARE: MR. MICHAEL DUANE RUTLEDGE L.C.S.W.

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	104100000X	Social Worker	24545	CA

General Provider Information

NPI Number	:	1770697401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL DUANE RUTLEDGE L.C.S.W.

Provider Business Mailing Address
First Line	:	9343 TECH CENTER DR
Second Line	:	SUITE 200
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-2563
Country	:	US
Telephone Number	:	916-351-2812
Fax Number	:	916-641-9599

Provider Business Practice Location Address
First Line	:	9343 TECH CENTER DR
Second Line	:	SUITE 200
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-2563
Country	:	US
Telephone Number	:	916-351-2812
Fax Number	:	916-641-9599

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	03/16/2012

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