MEDICARE: JAIME E RUIZ MONTERO MD

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	207R00000X	Internal Medicine Physician	01052348	IN
2	207R00000X	Internal Medicine Physician	01052348A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	90001247	OTHER	IL	BCBSIL
2	000000224980	OTHER	IN	ANTHEM
3	000000224980	OTHER		ANTHEM BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245360726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME E RUIZ MONTERO MD

Provider Business Mailing Address
First Line	:	9660 WICKER AVENUE
Second Line	:
City	:	ST JOHN
State	:	IN
Zip	:	46373-9487
Country	:	US
Telephone Number	:	219-397-8965
Fax Number	:	219-397-9351

Provider Business Practice Location Address
First Line	:	4320 FIR STREET
Second Line	:	SUITE 410
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-3052
Country	:	US
Telephone Number	:	219-397-8965
Fax Number	:	219-397-9351

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	01/04/2012

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Directions to “ JAIME E RUIZ MONTERO MD” Practice Location

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