Provider Demographics
NPI:1437131232
Name:RUPPENTHAL, MICHAEL LAMAR (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAMAR
Last Name:RUPPENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:625 GLENDALOUGH CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3056
Mailing Address - Country:US
Mailing Address - Phone:770-667-5403
Mailing Address - Fax:877-371-4608
Practice Address - Street 1:1530 PARKWAY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:864-330-9070
Practice Address - Fax:877-371-4608
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054925208100000X
SCTL30301208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI20140Medicare UPIN
GA25BBFXVMedicare ID - Type Unspecified