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NPI Code Detail

MEDICARE: DUANE P RUTZ OD

MEDICARE:   DUANE P RUTZ  OD
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
1152W00000XOptometrist1836MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
163520MCOTHERBCBS OF MN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790759090
Entity Type Code : Individual
Provider Name (Legal Business Name) : DUANE P RUTZ OD
Provider Business Mailing Address
First Line : PO BOX 549
Second Line :
City : PARK RAPIDS
State : MN
Zip : 56470-0549
Country : US
Telephone Number : 218-732-8535
Fax Number : 218-732-6957
Provider Business Practice Location Address
First Line : 204 S ATLANTIC
Second Line :
City : HALLOCK
State : MN
Zip : 56728
Country : US
Telephone Number : 218-843-2663
Fax Number : 218-843-2665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2006
Last Update Date : 04/12/2024

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Directions to “ DUANE P RUTZ OD” Practice Location

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