Provider Demographics
NPI:1194757864
Name:RUTHVEN, ALEXANDER GRANT II (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GRANT
Last Name:RUTHVEN
Suffix:II
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 1:1225 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5205
Mailing Address - Country:US
Mailing Address - Phone:810-987-6200
Mailing Address - Fax:
Practice Address - Street 1:1225 10TH ST
Practice Address - Street 2:HURON FAMILY PRACTICE CENTER
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5205
Practice Address - Country:US
Practice Address - Phone:810-987-6200
Practice Address - Fax:810-987-8717
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3042443Medicaid
MI4301030880OtherPHYSICIAN LICENSE
B47949Medicare UPIN