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General NPI Number Information
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NPI Number | 1578950804
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Entity Type | Individual
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Provider Name | JUSTIN MICHAEL RUTT D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 250 E SAGINAW ST
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City | EAST LANSING
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State | MI
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Zip | 48823-2740
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Country | US
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Telephone | 517-337-3080
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Fax |
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Provider Business Mailing Address
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Address Line | 7228 WERKNER RD
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City | CHELSEA
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State | MI
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Zip | 48118-9400
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Country | US
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Telephone | 348-883-5463
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101021600
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 1578950804
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License Number State | MI
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