Provider Demographics
NPI:1538162326
Name:RUTAN, GEORGE M (DPM, FACFAS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:RUTAN
Suffix:
Gender:M
Credentials:DPM, FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 RIDGE MILL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7799
Mailing Address - Country:US
Mailing Address - Phone:614-529-7800
Mailing Address - Fax:614-529-7802
Practice Address - Street 1:3663 RIDGE MILL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7799
Practice Address - Country:US
Practice Address - Phone:614-529-7800
Practice Address - Fax:614-529-7802
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001740213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0743593Medicaid
OHP00252830OtherRAILROAD MEDICARE
OH4118092Medicare PIN