Healthcare Provider Details

I. General information

NPI: 1588972343
Provider Name (Legal Business Name): JUAN PABLO RUIZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W DIVISION ST STE 260
CHICAGO IL
60622-2990
US

IV. Provider business mailing address

120 W 22ND ST STE 200
OAK BROOK IL
60523-1563
US

V. Phone/Fax

Practice location:
  • Phone: 773-489-6605
  • Fax: 872-829-3663
Mailing address:
  • Phone: 630-575-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036127114
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: