Healthcare Provider Details

I. General information

NPI: 1043293095
Provider Name (Legal Business Name): KIMBERLY ANN RUZEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 NOKOMIS AVE S
VENICE FL
34285-2817
US

IV. Provider business mailing address

P.O. BOX 1508
VENICE FL
34284-1508
US

V. Phone/Fax

Practice location:
  • Phone: 941-488-7781
  • Fax:
Mailing address:
  • Phone: 941-488-7781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number90361
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number43033
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: