Healthcare Provider Details

I. General information

NPI: 1902061914
Provider Name (Legal Business Name): JOHN MICHAEL RUTKOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2008
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 SAUNDERS SETTLEMENT RD
SANBORN NY
14132-9128
US

IV. Provider business mailing address

3085 HARLEM ROAD
CHEEKTOWAGA NY
14225
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-2800
  • Fax: 716-898-2805
Mailing address:
  • Phone: 716-844-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number264603
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: