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General NPI Number Information
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NPI Number | 1427289859
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Entity Type | Individual
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Provider Name | GRETEL RUIZ JORGE M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/03/2009
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 3010 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-4128
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Country | US
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Telephone | 847-220-4103
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Fax | 847-693-7029
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Provider Business Mailing Address
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Address Line | PO BOX 746715
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City | ATLANTA
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State | GA
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Zip | 30374-6715
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Country | US
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Telephone | 773-352-1515
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Fax | 312-929-0373
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 036.130192
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License Number State | IL
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