Healthcare Provider Details

I. General information

NPI: 1346392735
Provider Name (Legal Business Name): THEODORE J RUZA DO PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 BERRYHILL ST
WEST BLOOMFIELD MI
48322-5101
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 248-847-0070
  • Fax:
Mailing address:
  • Phone: 313-876-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101009905
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: