Healthcare Provider Details

I. General information

NPI: 1639185564
Provider Name (Legal Business Name): ROBERT J RUSKIEWICZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W WELLS ST
MILWAUKEE WI
53233-2720
US

IV. Provider business mailing address

1040 S 70TH STREET
MILWAUKEE WI
53214
US

V. Phone/Fax

Practice location:
  • Phone: 414-476-9675
  • Fax: 414-755-1834
Mailing address:
  • Phone: 414-476-9675
  • Fax: 414-615-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27783020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: