Provider Demographics
NPI:1124110382
Name:RUARK, DEBORAH SUE (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:SUE
Last Name:RUARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEBOARH
Other - Middle Name:SUE
Other - Last Name:RUARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1866 LINCOLNSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-4530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1866 LINCOLNSHIRE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-4530
Practice Address - Country:US
Practice Address - Phone:248-421-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064695208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F34069Medicare UPIN