MEDICARE: DR. ROBERT J. HRUSKOVICH 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	207Q00000X	Family Medicine Physician	52696	SC
2	207Q00000X	Family Medicine Physician	4301116232	MI
3	207Q00000X	Family Medicine Physician	MD046481	DC
4	207Q00000X	Family Medicine Physician	15405	ND
5	207Q00000X	Family Medicine Physician	R9778	TX
6	207Q00000X	Family Medicine Physician	01043972A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720078108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J. HRUSKOVICH MD

Provider Business Mailing Address
First Line	:	211 N EDDY ST.
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46617-3096
Country	:	US
Telephone Number	:	574-246-8816
Fax Number	:	574-204-6345

Provider Business Practice Location Address
First Line	:	211 N EDDY ST.
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46617-3096
Country	:	US
Telephone Number	:	574-246-8816
Fax Number	:	574-204-6345

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	09/11/2019

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