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NPI Code Detail

MEDICARE: DR. ROBERT THOMAS RUTKA MD

MEDICARE: DR. ROBERT THOMAS RUTKA MD
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
1207Q00000XFamily Medicine Physician27025MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477503688
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT THOMAS RUTKA MD
Provider Business Mailing Address
First Line : 901 9TH ST N
Second Line : SUITE 115
City : VIRGINIA
State : MN
Zip : 55792-2348
Country : US
Telephone Number : 218-748-7750
Fax Number : 218-742-8689
Provider Business Practice Location Address
First Line : 901 9TH ST N
Second Line : SUITE 115
City : VIRGINIA
State : MN
Zip : 55792-2348
Country : US
Telephone Number : 218-748-7750
Fax Number : 218-742-8689
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 06/22/2011

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