Basic Information
| Provider Information | |||||||||
| NPI: | 1538621263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUCK | ||||||||
| FirstName: | KATHERYNE | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5075 PARKWAY DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450409555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135846898 | ||||||||
| FaxNumber: | 5135846897 | ||||||||
| Practice Location | |||||||||
| Address1: | 5075 PARKWAY DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450409555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135846898 | ||||||||
| FaxNumber: | 5135846897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2019 | ||||||||
| LastUpdateDate: | 06/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | OH | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 34.014901 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.