Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 5101018589 | MI |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 5101018589 | MI |
Y | 207RG0300X | Geriatric Medicine | 5101018589 | MI |
NPI | 1184941841 |
---|---|
Provider Name | Stacey Marie Ruff |
First Address | Berkley, MI 48072-1868 |
Second Address | Berkley, MI 48072-1868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2010 |
Last Update Date | 23/10/2020 |