MEDICARE: ROBERT RUIZ

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	207Q00000X	Family Medicine Physician	039075	NC

General Provider Information

NPI Number	:	1396715447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT RUIZ

Provider Business Mailing Address
First Line	:	2834 GREEN BAY RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-3057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2834 GREEN BAY RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-3057
Country	:	US
Telephone Number	:	847-688-5520
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/08/2007

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