Individual
JOEL A RUETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7619 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 407-8009
Mailing address
PO BOX 5544, LAFAYETTE, IN 47903-5544
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001282A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
ANTHEM PROVIDER NUMBER
IN
Enumeration date
06/01/2011
Last updated
08/01/2017
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