Individual
JACK RUTKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4400 ROCKSIDE RD, SUITE 2100, INDEPENDENCE, OH 44131-2109
(216) 573-1300
Mailing address
4400 ROCKSIDE RD, SUITE 2100, INDEPENDENCE, OH 44131-2109
(216) 573-1300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35-088270
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000500020
ANTHEM
OH
01
—
000000590092
ANTHEM BLUE SHIELD
OH
05
—
2698540
—
OH
01
—
745390
BUCKEYE
OH
01
—
T88270
SUMMACARE
OH
Enumeration date
10/12/2006
Last updated
09/16/2020
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