MEDICARE: MAXWELL REID RUEGSEGGER DP-C

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1366070831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXWELL REID RUEGSEGGER DP-C

Provider Business Mailing Address
First Line	:	1480 N M 52 STE 1
Second Line	:
City	:	OWOSSO
State	:	MI
Zip	:	48867-1025
Country	:	US
Telephone Number	:	989-723-8230
Fax Number	:

Provider Business Practice Location Address
First Line	:	1480 N M 52
Second Line	:
City	:	OWOSSO
State	:	MI
Zip	:	48867-1290
Country	:	US
Telephone Number	:	989-723-8239
Fax Number	:	989-723-8230

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

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	03/19/2021

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Directions to “ MAXWELL REID RUEGSEGGER DP-C” Practice Location

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