Healthcare Provider Details

I. General information

NPI: 1700319530
Provider Name (Legal Business Name): PAUL THOMAS JUN DUK RUTKOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2017
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E TOWN ST
COLUMBUS OH
43215-4601
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-788-5000
  • Fax: 614-788-5100
Mailing address:
  • Phone: 614-788-5000
  • Fax: 614-788-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.136099
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number65748
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: