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NPI Code Detail

MEDICARE: DR. DUKE J RUKTANONCHAI M.D.

MEDICARE: DR. DUKE J RUKTANONCHAI M.D.
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
12084P0800XPsychiatry Physician036116196IL
22084P0800XPsychiatry PhysicianMD457852PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
202215643OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1629181037
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DUKE J RUKTANONCHAI M.D.
Provider Business Mailing Address
First Line : 2023 W GROVE DR
Second Line :
City : GIBSONIA
State : PA
Zip : 15044-6059
Country : US
Telephone Number : 630-306-4394
Fax Number :
Provider Business Practice Location Address
First Line : 1200 REEDSDALE ST
Second Line :
City : PITTSBURGH
State : PA
Zip : 15233-2109
Country : US
Telephone Number : 412-488-4040
Fax Number : 412-488-4097
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2006
Last Update Date : 11/11/2024

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