Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Kipp Edward Rustenholtz, PA-C

Individual provider Physician Assistant · NPI 1114193356

Mr. Kipp Edward Rustenholtz, PA-C is a Physician Assistant in Okemos, Michigan. Qualified in 2008, 18 years ago. Practices with Iha Health Services Corporation, a 1,146-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
18
Licensed in
MI
In the registry since
2008
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3413 Woods Edge
Okemos, MI 48864-5901
Phone: (517) 349-3303
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1881 W Grand River Ave, Okemos, MI 48864-1840 — (517) 339-2100

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (MI)

Record details

NPI number1114193356
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedMay 7, 2008
Last updated in NPPESNovember 15, 2024
Certification dateNovember 15, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Group practice Iha Health Services Corporation — 1146 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations13 on file with Medicare

Other providers in Okemos