Provider Demographics
NPI:1831378702
Name:MICHAEL L. RUPPENTHAL, P.C.
Entity type:Organization
Organization Name:MICHAEL L. RUPPENTHAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUPPENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-667-5403
Mailing Address - Street 1:625 GLENDALOUGH CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3056
Mailing Address - Country:US
Mailing Address - Phone:770-667-5403
Mailing Address - Fax:877-371-4608
Practice Address - Street 1:1530 PARKWAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4027
Practice Address - Country:US
Practice Address - Phone:864-330-9070
Practice Address - Fax:877-371-4608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30301283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
I20140Medicare UPIN