Individual
MR. JACOB B. RUTHSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
20333 W 151ST ST, OLATHE, KS 66061-5350
(913) 791-4357
(913) 381-0979
Mailing address
PO BOX 716, OVERLAND PARK, KS 66201-0716
(913) 642-4900
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0434990
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992970628
—
MO
01
—
45666017
BCBSKC
KS
01
—
9304670
AETNA
KS
Enumeration date
04/23/2008
Last updated
05/02/2017
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