Individual
RUTH A RUSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4480 CENTERVILLE RD, WHITE BEAR LAKE, MN 55127-3674
(651) 484-2724
(651) 484-2723
Mailing address
4480 CENTERVILLE RD, WHITE BEAR LAKE, MN 55127-3674
(651) 484-2724
(651) 484-2723
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
38316
MN
207R00000X
Internal Medicine Physician
38316
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110202652
RR MEDICARE
MN
Enumeration date
04/28/2006
Last updated
08/01/2012
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