Individual
CARL N RUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
(574) 537-2652
Mailing address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
(574) 537-2652
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01031869A
IN
2084P0804X
Child & Adolescent Psychiatry Physician
01031869A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000081164
ANTHEM
IN
05
—
100382500
—
IN
01
—
260012137
RAILROAD MEDICARE PIN
IN
Enumeration date
06/07/2006
Last updated
08/09/2011
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