Healthcare Provider Details

I. General information

NPI: 1801805825
Provider Name (Legal Business Name): JANET RUZYCKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S WOODS MILL RD
CHESTERFIELD MO
63017-3417
US

IV. Provider business mailing address

224 S WOODS MILL RD SUITE 210 SOUTH
CHESTERFIELD MO
63017-3451
US

V. Phone/Fax

Practice location:
  • Phone: 314-542-4897
  • Fax:
Mailing address:
  • Phone: 314-542-4897
  • Fax: 314-205-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR5D70
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: