MEDICARE: DR. JOANN EVIOTA RUIZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036085554	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992765283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANN EVIOTA RUIZ MD

Provider Business Mailing Address
First Line	:	5641 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4921
Country	:	US
Telephone Number	:	773-728-4784
Fax Number	:	773-728-4759

Provider Business Practice Location Address
First Line	:	5641 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4921
Country	:	US
Telephone Number	:	773-728-4784
Fax Number	:	773-728-4759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	10/26/2012

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