Healthcare Provider Details

I. General information

NPI: 1558011759
Provider Name (Legal Business Name): GREGORY PAUL RUZICH JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21202 OWENS RD STE 201
MOKENA IL
60448-2038
US

IV. Provider business mailing address

21202 OWENS RD STE 201
MOKENA IL
60448-2038
US

V. Phone/Fax

Practice location:
  • Phone: 779-334-0020
  • Fax: 779-334-0021
Mailing address:
  • Phone: 779-334-0020
  • Fax: 779-334-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036173012
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: