Healthcare Provider Details

I. General information

NPI: 1437184207
Provider Name (Legal Business Name): RUTH ANN WORTHINGTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 S CEDAR ST
LANSING MI
48910-3152
US

IV. Provider business mailing address

B545 WEST FEE HALL DEPARTMENT OF PEDIATRICS
EAST LANSING MI
48824-1315
US

V. Phone/Fax

Practice location:
  • Phone: 517-702-3500
  • Fax: 517-484-5169
Mailing address:
  • Phone: 517-353-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101007398
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: