Provider Demographics
NPI:1841259041
Name:RUTTEN, MICHAEL DANA (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DANA
Last Name:RUTTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 W. STEWART DR
Mailing Address - Street 2:SUITE 607
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3882
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1310 W. STEWART DR
Practice Address - Street 2:SUITE 607
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3882
Practice Address - Country:US
Practice Address - Phone:714-639-4901
Practice Address - Fax:714-771-5389
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG078366207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G783660Medicaid
CAWG78366AMedicare ID - Type Unspecified
CA00G783660Medicaid