Healthcare Provider Details

I. General information

NPI: 1902861495
Provider Name (Legal Business Name): HERMAN B RUIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 HEALTH PKWY
MT PLEASANT MI
48858-8931
US

IV. Provider business mailing address

2935 HEALTH PKWY
MT PLEASANT MI
48858-8931
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-1609
  • Fax: 989-953-4949
Mailing address:
  • Phone: 989-772-1609
  • Fax: 989-953-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number4301077496
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberHR077496
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: