MEDICARE: DR. LUIS R CRUZ 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	207RC0000X	Cardiovascular Disease Physician	016660	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010016660CT01	OTHER	CT	ANTHEM

General Provider Information

NPI Number	:	1609810480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS R CRUZ M.D.

Provider Business Mailing Address
First Line	:	1552 CHAPEL ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-4251
Country	:	US
Telephone Number	:	203-624-2117
Fax Number	:	203-624-5090

Provider Business Practice Location Address
First Line	:	1552 CHAPEL ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-4251
Country	:	US
Telephone Number	:	203-624-2117
Fax Number	:	203-624-5090

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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