Healthcare Provider Details

I. General information

NPI: 1609003334
Provider Name (Legal Business Name): RUPAM RUCHI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2009
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0224
US

IV. Provider business mailing address

1600 SW ARCHER RD BOX 100224
GAINESVILLE FL
32610-0224
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5357
  • Fax:
Mailing address:
  • Phone: 352-273-5357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301091961
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME118587
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: