MEDICARE: SHAWNA MARIE RUPLE 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
1	207V00000X	Obstetrics & Gynecology Physician	32605	SC

General Provider Information

NPI Number	:	1770803587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA MARIE RUPLE M.D.

Provider Business Mailing Address
First Line	:	3016 W. WACKERLY ST.
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48640-6960
Country	:	US
Telephone Number	:	989-631-6730
Fax Number	:	989-631-4398

Provider Business Practice Location Address
First Line	:	3016 W. WACKERLY ST.
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48640-6960
Country	:	US
Telephone Number	:	989-631-6730
Fax Number	:	989-631-4398

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

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	10/22/2021

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