| Doctor Name: | MICHAEL RUCKER |
| NPI Number: | 1164544193 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | PA2204 |
| Business Practice Address: | 5703 Red Bug Lake Rd Suite 180 Winter Springs, FL - 327084969 |
| Business Phone Number: | 4077014253 |
| Business Fax Number: | 4076794343 |
| Mailing Address: | 5703 Red Bug Lake Rd, Suite 180 WINTER SPRINGS |
| State: | FL |
| Postal Code: | 327084969 |
| Phone Number: | 4077014253 |
| Fax Number: | 4076794343 |
| NPI Enumeration Date: | 04/03/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | PA2204 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |