MEDICARE: DR. GRETEL RUIZ JORGE M.D.

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	036.130192	IL
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	036.130192	IL

General Provider Information

NPI Number	:	1427289859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRETEL RUIZ JORGE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 746715
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6715
Country	:	US
Telephone Number	:	847-220-4103
Fax Number	:	847-693-7029

Provider Business Practice Location Address
First Line	:	3010 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4128
Country	:	US
Telephone Number	:	847-220-4103
Fax Number	:	847-693-7029

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

Provider Enumeration Date	:	08/03/2009
Last Update Date	:	03/12/2026

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