Provider Demographics
NPI:1447349972
Name:RUTKOWSKI, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:RUTKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 ROCKSIDE RD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2109
Mailing Address - Country:US
Mailing Address - Phone:216-573-1300
Mailing Address - Fax:
Practice Address - Street 1:4400 ROCKSIDE RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2109
Practice Address - Country:US
Practice Address - Phone:216-573-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000500018OtherANTHEM
OH742504OtherBUCKEYE
OH000000590096OtherANTHEM BLUE SHIELD
OH2698531Medicaid
OHP00685087Medicare PIN
OH742504OtherBUCKEYE
OH4193851Medicare PIN
OH4193852Medicare PIN
OH000000590096OtherANTHEM BLUE SHIELD