Healthcare Provider Details

I. General information

NPI: 1033323449
Provider Name (Legal Business Name): THEODORE J RUZA DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 ORCHARD LAKE RD SUITE 424
WEST BLOOMFIELD MI
48322-3604
US

IV. Provider business mailing address

7001 ORCHARD LAKE RD SUITE 424
WEST BLOOMFIELD MI
48322-3604
US

V. Phone/Fax

Practice location:
  • Phone: 248-626-4600
  • Fax: 248-626-3988
Mailing address:
  • Phone: 248-626-4600
  • Fax: 248-626-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberTR009905
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberTR009905
License Number StateMI

VIII. Authorized Official

Name: DR. THEODORE J RUZA
Title or Position: OWNER
Credential: D.O.
Phone: 248-626-4600