MEDICARE: MARGARITA RUIZ PA-C, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085003106	IL

General Provider Information

NPI Number	:	1194998237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARITA RUIZ PA-C, MS

Provider Business Mailing Address
First Line	:	2363 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2939
Country	:	US
Telephone Number	:	773-278-7024
Fax Number	:	773-278-6948

Provider Business Practice Location Address
First Line	:	2359 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2939
Country	:	US
Telephone Number	:	773-278-7024
Fax Number	:	773-278-6948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	07/01/2021

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