Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | MD428373 | PA |
Y | 2080P0203X | Pediatric Critical Care Doctor | 42648 | KY |
N | 2080P0203X | Pediatric Critical Care Doctor | MD428373 | PA |
NPI | 1144413360 |
---|---|
Provider Name | Michael D Ruppe |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-1821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 04/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200959570 | (05) | IN |
7100077560 | (05) | KY |