Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | OS015467 | PA |
Y | 111NI0900X | Internist | OS015467 | PA |
NPI | 1003078254 |
---|---|
Provider Name | Dr. Paul Michael Rutkowski |
First Address | Duryea, PA 18642-1144 |
Second Address | Wilkes Barre, PA 18764-0999 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 17/06/2016 |