MEDICARE: MS. CYNTHIA ANN RUTKOWSKI MA, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	R364117

General Provider Information

NPI Number	:	1063479293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA ANN RUTKOWSKI MA, RD

Provider Business Mailing Address
First Line	:	22921 BUCKINGHAM ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-2806
Country	:	US
Telephone Number	:	313-278-5217
Fax Number	:	313-206-9085

Provider Business Practice Location Address
First Line	:	22921 BUCKINGHAM ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-2806
Country	:	US
Telephone Number	:	313-278-5217
Fax Number	:	313-206-9085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/08/2007

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