Provider Demographics
NPI:1487693073
Name:RUEBUSCH, MICHAEL J (CRNA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:RUEBUSCH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 643179
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3179
Mailing Address - Country:US
Mailing Address - Phone:937-293-0247
Mailing Address - Fax:
Practice Address - Street 1:600 WILSON CREEK ROAD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025
Practice Address - Country:US
Practice Address - Phone:812-537-1010
Practice Address - Fax:812-926-3209
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28149223A367500000X
OHNA047612367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN430077994OtherRAILROAD MEDICARE
OH2231525Medicaid
IN000000244194OtherANTHEM
IN200305070Medicaid
IN000000244194OtherANTHEM
OHRU8225141Medicare ID - Type Unspecified