Provider Demographics
NPI:1578950804
Name:RUTT, JUSTIN MICHAEL (DO)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:MICHAEL
Last Name:RUTT
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7228 WERKNER RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9400
Mailing Address - Country:US
Mailing Address - Phone:348-883-5463
Mailing Address - Fax:
Practice Address - Street 1:250 E SAGINAW ST
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2740
Practice Address - Country:US
Practice Address - Phone:517-337-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021600207Q00000X
MI1578950804204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine